Provider Demographics
NPI:1831467968
Name:MAERZKE, JENNIFER WALLACE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WALLACE
Last Name:MAERZKE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:8658 HOERNER AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3933
Mailing Address - Country:US
Mailing Address - Phone:405-850-1577
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2019-11-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant