Provider Demographics
NPI:1528716578
Name:BIERBAUM, JENNIFER FAYE (DNP, APRN-CNS, AGCNS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FAYE
Last Name:BIERBAUM
Suffix:
Gender:F
Credentials:DNP, APRN-CNS, AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SAVANNA DR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3286
Mailing Address - Country:US
Mailing Address - Phone:402-380-2485
Mailing Address - Fax:
Practice Address - Street 1:1033 SAVANNA DR
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3286
Practice Address - Country:US
Practice Address - Phone:402-380-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCS00141364SA2100X
MDR223734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care