Provider Demographics
NPI:1215264494
Name:DULIN, JENNIE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MARIE
Last Name:DULIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:MARIE
Other - Last Name:NIEWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S STE 401
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S STE 401
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6413
Practice Address - Country:US
Practice Address - Phone:410-224-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant