Provider Demographics
NPI:1689919961
Name:MCMANUS, JENNIFER L (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 PORT TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:NANJEMOY
Mailing Address - State:MD
Mailing Address - Zip Code:20662-3317
Mailing Address - Country:US
Mailing Address - Phone:240-417-6424
Mailing Address - Fax:
Practice Address - Street 1:4550 CRAIN HWY
Practice Address - Street 2:STE# 102
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3015
Practice Address - Country:US
Practice Address - Phone:301-349-2448
Practice Address - Fax:301-349-2243
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily