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General NPI Number Information
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NPI Number | 1417779133
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Entity Type | Individual
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Provider Name | JESSICA ROBIN MARSHALL HIS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1833 N KINSER PIKE
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City | BLOOMINGTON
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State | IN
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Zip | 47404-1914
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Country | US
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Telephone | 812-822-2892
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Fax | 812-822-2894
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Provider Business Mailing Address
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Address Line | 1833 N KINSER PIKE
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City | BLOOMINGTON
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State | IN
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Zip | 47404-1914
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Country | US
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Telephone | 812-519-3547
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Fax | 812-519-2853
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 17001652A
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License Number State | IN
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