Provider Demographics
NPI:1093755001
Name:WEMMER, JAN (CRNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:WEMMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64474
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 ORLEANS STREET, CRB II, ROOM 1M16
Practice Address - Street 2:JOHNS HOPKINS ONCOLOGY CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-8893
Practice Address - Fax:410-367-2194
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203331300Medicaid
MDKR52E576Medicare ID - Type Unspecified
MD203331300Medicaid