MEDICARE: MRS. JENNIE MARIE MARYLIW FNP-C

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	363LF0000X	Family Nurse Practitioner	4704165258	MI

General Provider Information

NPI Number	:	1548360662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIE MARIE MARYLIW FNP-C

Provider Business Mailing Address
First Line	:	5671 N SKEEL AVE
Second Line	:	SUITE 4
City	:	OSCODA
State	:	MI
Zip	:	48750-1535
Country	:	US
Telephone Number	:	989-747-0026
Fax Number	:	989-747-0029

Provider Business Practice Location Address
First Line	:	5671 N SKEEL AVE
Second Line	:	SUITE 4
City	:	OSCODA
State	:	MI
Zip	:	48750-1535
Country	:	US
Telephone Number	:	989-747-0026
Fax Number	:	989-747-0029

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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