Provider Demographics
NPI:1174902431
Name:PACHECO, JENNIFER (HHA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WISCONSIN AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3680
Mailing Address - Country:US
Mailing Address - Phone:202-955-8355
Mailing Address - Fax:
Practice Address - Street 1:1010 WISCONSIN AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3680
Practice Address - Country:US
Practice Address - Phone:202-955-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11268374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA374U00000XOtherNURSING SERVICE RELATED PROVIDER