MEDICARE: JENNIFER MARLOW LM, CPM

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	176B00000X	Midwife	99279	TX

General Provider Information

NPI Number	:	1093225799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARLOW LM, CPM

Provider Business Mailing Address
First Line	:	7345 SOUTHRIDGE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7126
Country	:	US
Telephone Number	:	770-855-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	7345 SOUTHRIDGE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7126
Country	:	US
Telephone Number	:	770-855-5585
Fax Number	:

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

Provider Enumeration Date	:	10/07/2017
Last Update Date	:	10/07/2017

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