Provider Demographics
NPI:1043193774
Name:MARX, JACLYN LEE
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:LEE
Last Name:MARX
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 1:765 HIGHWAY 51 LOT 2
Mailing Address - Street 2:
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791-3609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 N 18TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3652
Practice Address - Country:US
Practice Address - Phone:402-380-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care