Provider Demographics
NPI:1457808453
Name:HERRINGLONG, JAINE
Entity Type:Individual
Prefix:
First Name:JAINE
Middle Name:
Last Name:HERRINGLONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857 GREENBELT RD APT T3
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2451
Mailing Address - Country:US
Mailing Address - Phone:301-346-9901
Mailing Address - Fax:
Practice Address - Street 1:8857 GREENBELT RD APT T3
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2451
Practice Address - Country:US
Practice Address - Phone:301-346-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN50722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse