Provider Demographics
NPI:1710370861
Name:MARMOLEJO, JENEVA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENEVA
Middle Name:ANN
Last Name:MARMOLEJO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4222 WENDOVER AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5983
Mailing Address - Country:US
Mailing Address - Phone:432-552-5656
Mailing Address - Fax:432-332-8011
Practice Address - Street 1:3051 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7902
Practice Address - Country:US
Practice Address - Phone:432-362-4376
Practice Address - Fax:432-362-6308
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09757363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical