Provider Demographics
NPI:1588011167
Name:LANDERS, JENNA E (DO)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:E
Last Name:LANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 KING ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1908
Mailing Address - Country:US
Mailing Address - Phone:703-845-2812
Mailing Address - Fax:038-452-8137
Practice Address - Street 1:3610 KING ST STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1908
Practice Address - Country:US
Practice Address - Phone:703-845-2812
Practice Address - Fax:703-845-2813
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019858207Q00000X
VA0102207035207Q00000X
DCDO2000032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine