Provider Demographics
NPI:1447083951
Name:OSTERLOH, JENNIFER JEANNE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANNE
Last Name:OSTERLOH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 MERIDIAN CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4199
Mailing Address - Country:US
Mailing Address - Phone:549-240-6867
Mailing Address - Fax:
Practice Address - Street 1:3175 W WARD RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3024
Practice Address - Country:US
Practice Address - Phone:410-286-0664
Practice Address - Fax:410-286-2834
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204428163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty