Provider Demographics
NPI:1689117780
Name:HAUSER, JENNIFER P (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:HAUSER
Suffix:
Gender:
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 SADLER PL # 3557
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6122
Mailing Address - Country:US
Mailing Address - Phone:804-334-3802
Mailing Address - Fax:804-302-6501
Practice Address - Street 1:5231 HICKORY PARK DR STE D
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2619
Practice Address - Country:US
Practice Address - Phone:804-334-3802
Practice Address - Fax:804-302-6501
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001210613363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA024174296OtherMEDICARE
VA30016087300002Medicaid