Healthcare Provider Details

I. General information

NPI: 1164073375
Provider Name (Legal Business Name): JENNIFER NICOLE MARSH LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2019
Last Update Date: 09/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 COLBY AVE STE A
EVERETT WA
98201-3563
US

IV. Provider business mailing address

7119 55TH PL NE
MARYSVILLE WA
98270-8936
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-0157
  • Fax: 425-317-0756
Mailing address:
  • Phone: 206-701-4508
  • Fax: 425-317-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number61001637
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: