Jennifer Fullem, NP
Individual provider Active NPI Family Nurse Practitioner · Halethorpe, MD
NPI 1891345674 · NPPES record last updated Sep 19, 2022
Key facts
- NPI
- 1891345674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R191487 (MD)
- Practice address
- 1701 Twin Springs Rd
Halethorpe, MD 21227-3553 - Phone
- (410) 443-8874
- NPI assigned
- Sep 13, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R191487 | MD | |
| Family Nurse Practitioner | 363LF0000X | R191487 | MD | Yes |
Addresses
Primary practice location
1701 Twin Springs Rd
Halethorpe, MD 21227-3553
Mailing address
45 4TH St
New Freedom, PA 17349-9742
Phone (443) 465-0155
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Other providers in Halethorpe, MD
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- Nwamaka Tagbo Fadahunsi
- Alireza Payman Farsaii
- Latisha Flanigan
- Futures Health, Inc
- Mona Kaur Gahunia
- Jeffrey Gambel
- Genesis Physiatry Consultants LLC
- Jose Joshua Geronimo
All providers in Halethorpe, MD · Family Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.