Provider Demographics
NPI:1245788652
Name:MARR, JENNIFER (DNP, CPNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARR
Suffix:
Gender:F
Credentials:DNP, CPNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 PRAIRIE PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-222-2903
Mailing Address - Fax:319-222-2993
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-624-4031
Practice Address - Fax:507-624-4031
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC145251364SP0200X
MNCNP 4713363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP 4713OtherADVANCED PRACTICE REGISTERED NURSE NUMBER
IAC145251OtherADVANCED REGISTERED NURSE PRACTITIONER NUMBER