MEDICARE: JEAN K MARSEILLE

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
1	261QP2300X	Primary Care Clinic/Center
2	363LF0000X	Family Nurse Practitioner	F10170411	AZ

General Provider Information

NPI Number	:	1912417577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN K MARSEILLE

Provider Business Mailing Address
First Line	:	9111 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2515
Country	:	US
Telephone Number	:	602-255-7671
Fax Number	:

Provider Business Practice Location Address
First Line	:	9111 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2515
Country	:	US
Telephone Number	:	602-255-7671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	05/05/2018

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Directions to “ JEAN K MARSEILLE ” Practice Location

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