Provider Demographics
NPI:1659948651
Name:SUNDERLAND, JENNIFER LYNN (MSN, APRN, ACNPC-AG)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 FLEMING LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3073
Mailing Address - Country:US
Mailing Address - Phone:318-371-9979
Mailing Address - Fax:318-371-9949
Practice Address - Street 1:603 FLEMING LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3073
Practice Address - Country:US
Practice Address - Phone:318-371-9979
Practice Address - Fax:318-371-9949
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220309363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care