Individual
JENNIFER B. DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11800 SUNRISE VALLEY DR STE 500, RESTON, VA 20191-5303
(703) 437-5977
(703) 478-2475
Mailing address
2901 TELESTAR CT., #300, FALLS CHURCH, VA 22042-1261
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024119682
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457399206
—
VA
01
—
P01300807
RAILROAD MEDICARE PIN
DC
Enumeration date
06/03/2006
Last updated
07/14/2023
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