Provider Demographics
NPI:1548360662
Name:MARYLIW, JENNIE MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MARIE
Last Name:MARYLIW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5671 N SKEEL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1535
Mailing Address - Country:US
Mailing Address - Phone:989-747-0026
Mailing Address - Fax:989-747-0029
Practice Address - Street 1:5671 N SKEEL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1535
Practice Address - Country:US
Practice Address - Phone:989-747-0026
Practice Address - Fax:989-747-0029
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily