Individual
JENELLE CHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
630 FARRAGUT ST NW, WASHINGTON, DC 20011-4010
(202) 547-3714
Mailing address
14108 BRAMBLE CT APT T2, LAUREL, MD 20708-1214
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
MT0139037
MD
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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