Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024179468 | VA |
NPI | 1174142160 |
---|---|
Provider Name | Jennifer Corser Hymel |
First Address | Herndon, VA 20171-2667 |
Second Address | Falls Church, VA 22042-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 01/07/2020 |