Provider Demographics
NPI:1619060720
Name:AUSTIN, JENNIE RD (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:RD
Last Name:AUSTIN
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Gender:F
Credentials:RN, MSN, CPNP
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Mailing Address - Street 1:4525 S CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4758
Mailing Address - Country:US
Mailing Address - Phone:202-782-4184
Mailing Address - Fax:202-782-5387
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:DEPT PEDS, EDIS, BUILDING 41, 6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-4184
Practice Address - Fax:202-782-5387
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN35367363LP0200X
MDRO92724363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics