MEDICARE: JENNIFER L MCMANUS C.R.N.P

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
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	6698	MD
2	363LF0000X	Family Nurse Practitioner	R120765	MD

General Provider Information

NPI Number	:	1689919961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L MCMANUS C.R.N.P

Provider Business Mailing Address
First Line	:	5140 PORT TOBACCO RD
Second Line	:
City	:	NANJEMOY
State	:	MD
Zip	:	20662-3317
Country	:	US
Telephone Number	:	240-417-6424
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 POST OFFICE RD STE 304
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3704
Country	:	US
Telephone Number	:	301-349-2448
Fax Number	:	301-349-2243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	12/19/2024

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