Healthcare Provider Details

I. General information

NPI: 1093225799
Provider Name (Legal Business Name): JENNIFER MARLOW LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 10/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 SOUTHRIDGE TRL
FORT WORTH TX
76133-7126
US

IV. Provider business mailing address

7345 SOUTHRIDGE TRL
FORT WORTH TX
76133-7126
US

V. Phone/Fax

Practice location:
  • Phone: 770-855-5585
  • Fax:
Mailing address:
  • Phone: 770-855-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: