Provider Demographics
NPI:1689005423
Name:MARSHALL, JENNIFER (CNT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3440
Mailing Address - Country:US
Mailing Address - Phone:720-352-8769
Mailing Address - Fax:
Practice Address - Street 1:921 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1882
Practice Address - Country:US
Practice Address - Phone:720-352-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist