Healthcare Provider Details

I. General information

NPI: 1932671005
Provider Name (Legal Business Name): JENNIFER LYNN MARMOLEJO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN HINRICHS RN

II. Dates (important events)

Enumeration Date: 12/29/2018
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E. ILLINOIS AVE SUITE 201
FRESNO CA
93701-2125
US

IV. Provider business mailing address

3812 N. 1ST ST.
FRESNO CA
93726-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-8888
  • Fax:
Mailing address:
  • Phone: 559-495-3120
  • Fax: 559-495-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL29879
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberF11181024
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF11181024
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF11181024
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF11181024
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF11181024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: