Provider Demographics
NPI:1801359682
Name:MARKLEY, JENNA K
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:K
Last Name:MARKLEY
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 1:9434 LIMA RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-2000
Mailing Address - Country:US
Mailing Address - Phone:260-580-3630
Mailing Address - Fax:
Practice Address - Street 1:9434 LIMA RD STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-2000
Practice Address - Country:US
Practice Address - Phone:260-580-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist