Provider Demographics
NPI:1891289807
Name:JENIEC, ASHLEY CADWALLADER (C-PNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CADWALLADER
Last Name:JENIEC
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 LEEDS MANOR RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-2218
Mailing Address - Country:US
Mailing Address - Phone:703-927-6354
Mailing Address - Fax:
Practice Address - Street 1:28 BLACKWELL PARK LN STE 103
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2686
Practice Address - Country:US
Practice Address - Phone:540-349-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176234363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics