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NPI Code Detail

MEDICARE: JASON LYNN MARSH AGPCNP-BC

MEDICARE: JASON LYNN MARSH AGPCNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner71011767AIN
2363LG0600XGerontology Nurse Practitioner71011767AIN

General Provider Information

NPI Number : 1639834575
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON LYNN MARSH AGPCNP-BC
Provider Business Mailing Address
First Line : PO BOX 735377
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5377
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2640 COLD SPRING RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222-2272
Country : US
Telephone Number : 317-634-8330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2021
Last Update Date : 03/21/2024

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