Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99279 | TX |
NPI | 1093225799 |
---|---|
Provider Name | Jennifer Marlow |
First Address | Fort Worth, TX 76133-7126 |
Second Address | Fort Worth, TX 76133-7126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2017 |
Last Update Date | 07/10/2017 |