Provider Demographics
NPI:1437948650
Name:NANJO, JACOB CHICK (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHICK
Last Name:NANJO
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 JAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-7403
Mailing Address - Country:US
Mailing Address - Phone:301-728-9987
Mailing Address - Fax:
Practice Address - Street 1:2749 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3140
Practice Address - Country:US
Practice Address - Phone:301-728-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse