Provider Demographics
NPI:1710558952
Name:JARVIS, MARSHA SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:SUZANNE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:RN
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 402
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-0402
Mailing Address - Country:US
Mailing Address - Phone:605-430-2704
Mailing Address - Fax:
Practice Address - Street 1:158 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-6058
Practice Address - Country:US
Practice Address - Phone:605-430-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR031706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse