Provider Demographics
NPI:1225381437
Name:BAINUM, JENNIFER L (CPNP, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BAINUM
Suffix:
Gender:F
Credentials:CPNP, PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:925 OLD HOMESTEAD LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4013
Mailing Address - Country:US
Mailing Address - Phone:619-417-0654
Mailing Address - Fax:757-432-3269
Practice Address - Street 1:1577 WILROY RD STE 102
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2433
Practice Address - Country:US
Practice Address - Phone:757-204-5775
Practice Address - Fax:757-257-2320
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95011573363LP0200X, 363LP0808X
VA0024177886363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics