Individual
JENNIFER MARAVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CG
Contact information
Practice address
11719 NE 95TH ST STE D, VANCOUVER, WA 98682-2444
(360) 397-8246
Mailing address
PO BOX 1678, VANCOUVER, WA 98668-1678
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CG61205179
WA
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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