Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 62906 | MN |
N | 2080P0208X | Pediatric Infectious Diseases | 62906 | MN |
NPI | 1568789006 |
---|---|
Provider Name | Ketzela Jacobowitz Marsh |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 06/09/2018 |