Provider Demographics
NPI:1629844808
Name:WAYTOVICH, JEANNIE (AGNP)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:WAYTOVICH
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 WOODSTOCK CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1262
Mailing Address - Country:US
Mailing Address - Phone:813-486-1577
Mailing Address - Fax:
Practice Address - Street 1:11200 ROCKVILLE PIKE STE 205
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3103
Practice Address - Country:US
Practice Address - Phone:301-770-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR26361163WG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology