Provider Demographics
NPI:1376784371
Name:RICHARDSON, JENNIFER MARZOLF (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARZOLF
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELE
Other - Last Name:MARZOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1207 HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:252-946-6513
Mailing Address - Fax:252-948-0808
Practice Address - Street 1:1207 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889
Practice Address - Country:US
Practice Address - Phone:252-946-6513
Practice Address - Fax:252-948-0808
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1520AMedicare UPIN