Provider Demographics
NPI:1609427350
Name:MARCUS, JESSICA ROBIN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBIN
Last Name:MARCUS
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 1:101 1ST ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5605
Mailing Address - Country:US
Mailing Address - Phone:540-980-0550
Mailing Address - Fax:540-980-9141
Practice Address - Street 1:101 1ST ST NW STE 2
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5605
Practice Address - Country:US
Practice Address - Phone:540-980-0550
Practice Address - Fax:540-980-9141
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103775363LF0000X
VA0024177982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily