Provider Demographics
NPI:1639379852
Name:BARTLETT, JANE BLAIR (NP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:BLAIR
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:2700 PROSPERITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4321
Practice Address - Country:US
Practice Address - Phone:703-698-2431
Practice Address - Fax:571-665-6878
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN50872363L00000X
VA0024147646363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001147646OtherLICENSE