1790020741 NPI number — MISS JENNIFER LYNN NERF PA-C, RD, MSHS

Table of content: MISS JENNIFER LYNN NERF PA-C, RD, MSHS (NPI 1790020741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790020741 NPI number — MISS JENNIFER LYNN NERF PA-C, RD, MSHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NERF
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C, RD, MSHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790020741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-8040
Provider Business Mailing Address Fax Number:
443-462-3514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-5780
Provider Business Practice Location Address Fax Number:
410-328-8315
Provider Enumeration Date:
12/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  C0004901 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1107436 . This is a "NCCPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 812564 . This is a "CDR" identifier . This identifiers is of the category "OTHER".
  • Identifier: C0004901 . This is a "STATE OF MARYLAND OF LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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