Provider Demographics
NPI:1609193671
Name:LANDRETTE, JENNIFER KATIE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATIE
Last Name:LANDRETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PENNSYLVANIA AVE SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2167
Mailing Address - Country:US
Mailing Address - Phone:202-546-1512
Mailing Address - Fax:202-544-5365
Practice Address - Street 1:801 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2167
Practice Address - Country:US
Practice Address - Phone:202-546-1512
Practice Address - Fax:202-544-5365
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186255163W00000X
DCRN1016394163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse