Provider Demographics
NPI:1033831300
Name:WASHBURN, JENNIFER L (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:G
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2701 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1624
Mailing Address - Country:US
Mailing Address - Phone:804-712-1391
Mailing Address - Fax:804-835-5109
Practice Address - Street 1:2701 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1624
Practice Address - Country:US
Practice Address - Phone:804-214-2417
Practice Address - Fax:804-835-5109
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001206166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5493OtherBUSINESS LICENSE FOR PROFESSIONAL