Provider Demographics
NPI:1952732588
Name:KITTNER, JANINE SPROULES (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:SPROULES
Last Name:KITTNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:LOUISE
Other - Last Name:SPROULES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:1625 N GEORGE MASON DR STE 288
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-558-6491
Practice Address - Fax:703-524-4365
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952732588Medicaid
VA350524YA5WMedicare UPIN