MEDICARE: MARSHA SUZANNE JARVIS RN

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	163W00000X	Registered Nurse	R031706	SD

General Provider Information

NPI Number	:	1710558952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA SUZANNE JARVIS RN

Provider Business Mailing Address
First Line	:	PO BOX 402
Second Line	:
City	:	HILL CITY
State	:	SD
Zip	:	57745-0402
Country	:	US
Telephone Number	:	605-430-2704
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 PONDEROSA AVE
Second Line	:
City	:	HILL CITY
State	:	SD
Zip	:	57745-6058
Country	:	US
Telephone Number	:	605-430-2704
Fax Number	:

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

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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