Provider Demographics
NPI:1699741751
Name:NORWOOD, JENNIFER BURNS (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BURNS
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3858
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3858
Mailing Address - Country:US
Mailing Address - Phone:318-636-9905
Mailing Address - Fax:318-636-5102
Practice Address - Street 1:2751 ALBERT BICKNELL DRIVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3976
Practice Address - Country:US
Practice Address - Phone:318-636-9905
Practice Address - Fax:318-636-5102
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN036678 APO3173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP72065Medicare UPIN