Provider Demographics
NPI:1518511849
Name:PETERSON, JENNIFER M (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY STE 510
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3747
Mailing Address - Country:US
Mailing Address - Phone:410-897-0822
Mailing Address - Fax:410-897-0095
Practice Address - Street 1:2000 MEDICAL PKWY STE 510
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3747
Practice Address - Country:US
Practice Address - Phone:410-897-0822
Practice Address - Fax:410-897-0095
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR201261OtherLICENSE NUMBER