Provider Demographics
NPI:1538519855
Name:JENDRAS, MARISA ANNE
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANNE
Last Name:JENDRAS
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 1:320 KENNESTONE HOSPITAL BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1161
Practice Address - Country:US
Practice Address - Phone:770-793-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS