Healthcare Provider Details

I. General information

NPI: 1194700245
Provider Name (Legal Business Name): MARION WAYNE KISER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE ROAD ANESTHESIA INTENSIVE CARE CONSULTANTS INC
CINCINNATI OH
45255
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DRIVE SUITE 258 MILLENIUM ANESTHESIA LLC
EDGEWOOD KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number167349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: