Provider Demographics
NPI:1093225799
Name:MARLOW, JENNIFER (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARLOW
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 SOUTHRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7126
Mailing Address - Country:US
Mailing Address - Phone:770-855-5585
Mailing Address - Fax:
Practice Address - Street 1:7345 SOUTHRIDGE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7126
Practice Address - Country:US
Practice Address - Phone:770-855-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99279176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife