Healthcare Provider Details

I. General information

NPI: 1528648920
Provider Name (Legal Business Name): MILENA ANEZKA MARSHALL DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC SIGONELLA PSC 836 BOX 2670
FPO AE
09636-9998
US

IV. Provider business mailing address

NMRTC SIGONELLA PSC 836 BOX 2670
FPO AE
09636
US

V. Phone/Fax

Practice location:
  • Phone: 909-586-3842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704306408
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704306408
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95236926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: