Provider Demographics
NPI:1962722611
Name:JANG, ALICE ONE (CPNP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ONE
Last Name:JANG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2606
Mailing Address - Country:US
Mailing Address - Phone:301-681-7101
Mailing Address - Fax:855-885-1472
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-681-7101
Practice Address - Fax:855-885-1472
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2017-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR225379163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse