Provider Demographics
NPI:1568682292
Name:DERUGEN, JENNIFER S (LM CPM)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
Last Name:DERUGEN
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HAMPTON BLVD
Mailing Address - Street 2:APT A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517
Mailing Address - Country:US
Mailing Address - Phone:757-622-2791
Mailing Address - Fax:
Practice Address - Street 1:1700 HAMPTON BLVD
Practice Address - Street 2:APT A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517
Practice Address - Country:US
Practice Address - Phone:757-622-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000010176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife