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NPI Code Detail

MEDICARE: JENNIFER B. DURHAM NP

MEDICARE: JENNIFER B. DURHAM NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0024119682VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01300807OTHERDCRAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457399206
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER B. DURHAM NP
Provider Business Mailing Address
First Line : 2901 TELESTAR CT.
Second Line : #300
City : FALLS CHURCH
State : VA
Zip : 22042-1261
Country : US
Telephone Number : 703-591-1688
Fax Number : 703-591-1445
Provider Business Practice Location Address
First Line : 11800 SUNRISE VALLEY DR STE 500
Second Line :
City : RESTON
State : VA
Zip : 20191-5303
Country : US
Telephone Number : 703-437-5977
Fax Number : 703-478-2475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 07/14/2023

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