MEDICARE: MS. JENNIFER JANE FOSS 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
1	363LA2200X	Adult Health Nurse Practitioner	0024121945	VA

General Provider Information

NPI Number	:	1770843690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER JANE FOSS NP

Provider Business Mailing Address
First Line	:	OLD DOMINION UNIVERSITY STUDENT
Second Line	:	1007 SOUTH WEBB CENTER
City	:	NORFOLK
State	:	VA
Zip	:	23529-0001
Country	:	US
Telephone Number	:	757-683-3132
Fax Number	:	757-683-5930

Provider Business Practice Location Address
First Line	:	OLD DOMINION UNIVERSITY STUDENT
Second Line	:	1007 SOUTH WEBB CENTER
City	:	NORFOLK
State	:	VA
Zip	:	23529-0001
Country	:	US
Telephone Number	:	757-683-3132
Fax Number	:	757-683-5930

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

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	05/24/2012

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