Healthcare Provider Details

I. General information

NPI: 1447300736
Provider Name (Legal Business Name): MARLEN BOB JOST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SYCAMORE CT STE 1B
COLUMBUS IN
47203-1545
US

IV. Provider business mailing address

3200 SYCAMORE CT STE 1B
COLUMBUS IN
47203-1545
US

V. Phone/Fax

Practice location:
  • Phone: 812-378-9027
  • Fax: 812-378-1014
Mailing address:
  • Phone: 812-378-9027
  • Fax: 812-378-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704256530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: