Healthcare Provider Details

I. General information

NPI: 1023604915
Provider Name (Legal Business Name): CHRISTINA M MARSH AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 VERN DR
ANCHORAGE AK
99516-2690
US

IV. Provider business mailing address

13650 VERN DR
ANCHORAGE AK
99516-2690
US

V. Phone/Fax

Practice location:
  • Phone: 805-728-5470
  • Fax:
Mailing address:
  • Phone: 805-728-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberNURR36339
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number170304
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: