1619036175 NPI number — STEPHANIE GISELE MARBLE DNAP, CRNA

Table of content: DR. JOAN MICHELLE CHRISTIE MD (NPI 1245275585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619036175 NPI number — STEPHANIE GISELE MARBLE DNAP, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARBLE
Provider First Name:
STEPHANIE
Provider Middle Name:
GISELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNAP, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSSELL
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
GISELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619036175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3646 WAITS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWEGO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13827-6504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-396-6476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GUTHRIE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18840-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-887-5564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

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:  076390 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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