Provider Demographics
NPI:1669723607
Name:MARRIOTT, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:NATALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 COUNTY HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13439-4722
Mailing Address - Country:US
Mailing Address - Phone:315-858-5448
Mailing Address - Fax:
Practice Address - Street 1:1040 COUNTY HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:RICHFIELD SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13439-4722
Practice Address - Country:US
Practice Address - Phone:315-858-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310773-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse