1568731396 NPI number — MARKA PARSONS CRNA

Table of content: MARKA PARSONS CRNA (NPI 1568731396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568731396 NPI number — MARKA PARSONS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARSONS
Provider First Name:
MARKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
MARKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568731396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23311 175TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAVENWORTH
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66048-6382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-550-3152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 S DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAPULPA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74066-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-550-3152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  14116945091 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)