Provider Demographics
NPI:1558674606
Name:WARE, JEANANNE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JEANANNE
Middle Name:MARIE
Last Name:WARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DR
Mailing Address - Street 2:BUILDING 10, ROOM 8N234-A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-594-3149
Mailing Address - Fax:301-451-2029
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BUILDING 10, ROOM 8N234-A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-594-3149
Practice Address - Fax:301-451-2029
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily