Provider Demographics
NPI:1366130544
Name:MARSTORP, JACQUELYNE
Entity type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:
Last Name:MARSTORP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34168 AMICI ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5583
Mailing Address - Country:US
Mailing Address - Phone:760-807-9733
Mailing Address - Fax:
Practice Address - Street 1:34168 AMICI ST
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5583
Practice Address - Country:US
Practice Address - Phone:760-807-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249268164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse