Provider Demographics
NPI:1770895906
Name:LOUIS-JACQUES, MARJORIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:
Last Name:LOUIS-JACQUES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FIVE POINTS ROAD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-796-5795
Mailing Address - Fax:732-796-5795
Practice Address - Street 1:15 FIVE POINTS ROAD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-796-5795
Practice Address - Fax:732-796-5795
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00275800363L00000X, 363LF0000X
NY339159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20215060Medicare UPIN
NJ202125060Medicare UPIN