Provider Demographics
NPI:1942801683
Name:MARTIN, JACQUISE C
Entity Type:Individual
Prefix:
First Name:JACQUISE
Middle Name:C
Last Name:MARTIN
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 1:1712 JANUARY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6972
Mailing Address - Country:US
Mailing Address - Phone:202-948-8808
Mailing Address - Fax:
Practice Address - Street 1:2801 14TH ST NW APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4946
Practice Address - Country:US
Practice Address - Phone:202-948-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant