Provider Demographics
NPI:1356115158
Name:SIGWALT, JENNIFER R (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:SIGWALT
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 1:8946 WOOD CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2449
Mailing Address - Country:US
Mailing Address - Phone:410-845-1436
Mailing Address - Fax:
Practice Address - Street 1:8946 WOOD CREEK PKWY
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2449
Practice Address - Country:US
Practice Address - Phone:410-845-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217536363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care