Provider Demographics
NPI:1497078745
Name:JEWELL, MARLENE JO
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:JO
Last Name:JEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45886-0007
Mailing Address - Country:US
Mailing Address - Phone:419-622-3505
Mailing Address - Fax:
Practice Address - Street 1:482 S. SHERMAN ST.
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:OH
Practice Address - Zip Code:45886
Practice Address - Country:US
Practice Address - Phone:419-622-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide