| |
5000 Nannie Helen Burroughs Ave Ne Washington DC 20019-5506 | |
(202) 399-7504 | |
(240) 441-2532 |
Full Name | |
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Speciality | Nurse Practitioner |
Location | 5000 Nannie Helen Burroughs Ave Ne, Washington, District Of Columbia |
Authorized Official Name and Position | Jasline J Jesson-petersen (PRESIDENT) |
Authorized Official Contact | 2404412532 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1422 Geranium St Nw Washington DC 20012-1518 Ph: (240) 441-2532 | 5000 Nannie Helen Burroughs Ave Ne Washington DC 20019-5506 Ph: (202) 399-7504 |
NPI Number | 1205350881 |
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Provider Enumeration Date | 07/26/2017 |
Last Update Date | 03/17/2018 |
Medicare PECOS PAC ID | 5496025157 |
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Medicare Enrollment ID | O20180517001110 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205350881 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
363LP2300X | Nurse Practitioner - Primary Care | RN1023884 (District Of Columbia) | Primary |
Provider Name | Jasline J Jesson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225305774 PECOS PAC ID: 8921363144 Enrollment ID: I20180517001542 |
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