Provider Demographics
NPI:1184946246
Name:MAROTTA-JAENECKE, JASMINE ALLEGRA (CPM, LM)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:ALLEGRA
Last Name:MAROTTA-JAENECKE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N PASEO DE LOS RIOS APT 14202
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6086
Mailing Address - Country:US
Mailing Address - Phone:650-393-9690
Mailing Address - Fax:866-421-0311
Practice Address - Street 1:3300 N PASEO DE LOS RIOS APT 14202
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6086
Practice Address - Country:US
Practice Address - Phone:650-393-9690
Practice Address - Fax:866-421-0311
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 60563122176B00000X
ORDEM-LD-10159323176B00000X
CALM508176B00000X
374J00000X
AZLM243176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula