Healthcare Provider Details

I. General information

NPI: 1164527255
Provider Name (Legal Business Name): ELIZABETH C MARKS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E 3RD ST
DULUTH MN
55805-1950
US

IV. Provider business mailing address

615 E SKYLINE PKWY
DULUTH MN
55805-1145
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3167
  • Fax: 218-722-8792
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1309014
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: