Provider Demographics
NPI:1710197306
Name:EXNER, JANE F (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:EXNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-4408
Mailing Address - Fax:410-328-1112
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-4408
Practice Address - Fax:410-328-1112
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR142270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD954068-01 & 02OtherBLUE CROSS/BLUE SHIELD
MD418037200Medicaid
MDS062-0365OtherBLUE CROSS/BLUE SHIELD REGIONAL
MDS062-0365OtherBLUE CROSS/BLUE SHIELD REGIONAL