Provider Demographics
NPI:1467114173
Name:LICHTENBERG, JENNA LEIGH
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:LICHTENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE STE 1250
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4314
Mailing Address - Country:US
Mailing Address - Phone:301-652-1231
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1250
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4314
Practice Address - Country:US
Practice Address - Phone:301-652-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant