Provider Demographics
NPI:1316982457
Name:FELLMAN, JENNIFER L (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:FELLMAN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:FETTERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 GLENROCK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3767
Mailing Address - Country:US
Mailing Address - Phone:757-252-3236
Mailing Address - Fax:757-222-3108
Practice Address - Street 1:835 GLENROCK RD STE 110
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:757-252-3236
Practice Address - Fax:757-222-3108
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316982457Medicaid
VA1316982457Medicaid