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General NPI Number Information
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NPI Number | 1912451618
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Entity Type | Individual
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Provider Name | JANE TRAVIS
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Gender | Female
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 8118 GOOD LUCK RD
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City | LANHAM
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State | MD
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Zip | 20706-3574
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Country | US
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Telephone | 301-552-8665
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Fax |
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Provider Business Mailing Address
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Address Line | 127 3RD ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-7313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA031277
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License Number State | DC
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