Provider Demographics
NPI:1497992366
Name:BLANDING, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLANDING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ELDEN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4861
Mailing Address - Country:US
Mailing Address - Phone:703-709-0832
Mailing Address - Fax:703-689-0139
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:703-709-0832
Practice Address - Fax:703-689-0139
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant