Provider Demographics
NPI:1548440381
Name:MAUNE, JERENE M (NP-C)
Entity type:Individual
Prefix:
First Name:JERENE
Middle Name:M
Last Name:MAUNE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 COLLINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1726
Mailing Address - Country:US
Mailing Address - Phone:202-909-6963
Mailing Address - Fax:
Practice Address - Street 1:700 12TH ST NW
Practice Address - Street 2:SUITE 700
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3945
Practice Address - Country:US
Practice Address - Phone:202-909-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000557363LA2200X
VA0024165964363LA2200X
DCRN53635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health