Basic Information
| Provider Information | |||||||||
| NPI: | 1508372418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMONOO-HARRISON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | RN/LC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16300 CATENARY DR | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221916036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714773406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6501 LOISDALE CT | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221501826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039221000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2017 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-48514 | VA | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.