Provider Demographics
NPI:1689117780
Name:HAUSER, JENNIFER P (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:HAUSER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 LAKESIDE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5735
Mailing Address - Country:US
Mailing Address - Phone:804-334-3802
Mailing Address - Fax:804-302-6501
Practice Address - Street 1:6001 LAKESIDE AVE STE 7
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5735
Practice Address - Country:US
Practice Address - Phone:804-334-3802
Practice Address - Fax:804-302-6501
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001210613363LA2200X, 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
VA024174296OtherMEDICARE