Provider Demographics
NPI:1174064752
Name:MANDEL, JENNIFER L (CPNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MANDEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Mailing Address - Street 1:2111 LAUREL BUSH RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6156
Mailing Address - Country:US
Mailing Address - Phone:410-569-3300
Mailing Address - Fax:410-515-2027
Practice Address - Street 1:2111 LAUREL BUSH RD
Practice Address - Street 2:SUITE H
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-569-3300
Practice Address - Fax:410-515-2027
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2018-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR202736363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics