Provider Demographics
NPI:1285818690
Name:PUFFENBERGER, JAN L (RN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:PUFFENBERGER
Suffix:
Gender:F
Credentials:RN
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 1568
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-6568
Mailing Address - Country:US
Mailing Address - Phone:540-825-3100
Mailing Address - Fax:540-825-6245
Practice Address - Street 1:340 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3006
Practice Address - Country:US
Practice Address - Phone:540-347-7620
Practice Address - Fax:540-349-0644
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001092572163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945361Medicaid