Provider Demographics
NPI:1013372960
Name:SERRY, JENEH
Entity Type:Individual
Prefix:
First Name:JENEH
Middle Name:
Last Name:SERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 STEWART LN
Mailing Address - Street 2:APT.504
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2269
Mailing Address - Country:US
Mailing Address - Phone:301-366-3379
Mailing Address - Fax:
Practice Address - Street 1:11550 STEWART LN
Practice Address - Street 2:APT.504
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2269
Practice Address - Country:US
Practice Address - Phone:301-366-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1004374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse