Provider Demographics
NPI:1790030989
Name:GHADISHA, JENNIFER ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:GHADISHA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3742
Mailing Address - Country:US
Mailing Address - Phone:410-571-9700
Mailing Address - Fax:470-571-9710
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-571-9700
Practice Address - Fax:470-571-9710
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2016-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVAPN001403363LW0102X
MDR158431363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health