Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | DO-05285 | IA |
NPI | 1033163647 |
---|---|
Provider Name | Jennifer Elizabeth Marks |
First Address | Dubuque, IA 52002-2201 |
Second Address | Dubuque, IA 52002-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I54889 | (02) |