Provider Demographics
NPI:1508259904
Name:FENTON, JILL (APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:2-PHC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-8849
Mailing Address - Fax:301-306-8583
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:2-PHC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8849
Practice Address - Fax:301-306-8583
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1037092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner