Provider Demographics
NPI:1093432809
Name:JACKSON-BICKERSTETH, JENNIFER EKUNDAYO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:EKUNDAYO
Last Name:JACKSON-BICKERSTETH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 MARSDEN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6858
Mailing Address - Country:US
Mailing Address - Phone:240-604-2561
Mailing Address - Fax:
Practice Address - Street 1:6040 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1848
Practice Address - Country:US
Practice Address - Phone:301-715-3673
Practice Address - Fax:888-496-8354
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP42512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse