Individual
MISS JENNIFER LACEY PANTOJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
61 THOMAS JOHNSON DR STE B, FREDERICK, MD 21702-4301
(240) 215-0454
Mailing address
20805 FAIRWAY VIEW DR, GAITHERSBURG, MD 20882-1841
(434) 610-9811
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R218266
MD
Other
Enumeration date
02/22/2016
Last updated
08/26/2024
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