Provider Demographics
NPI:1164073375
Name:MARSH, JENNIFER NICOLE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:MARSH
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 1:7119 55TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8936
Mailing Address - Country:US
Mailing Address - Phone:206-701-4508
Mailing Address - Fax:425-317-0756
Practice Address - Street 1:2808 COLBY AVE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3563
Practice Address - Country:US
Practice Address - Phone:425-317-0157
Practice Address - Fax:425-317-0756
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61001637176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife