Provider Demographics
NPI:1376694349
Name:ANDERSON, JEAN A (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNP
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Other - Last Name:
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:201 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-237-4000
Practice Address - Fax:703-536-1400
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S97324Medicare UPIN
012970K92Medicare UPIN