Healthcare Provider Details

I. General information

NPI: 1043278435
Provider Name (Legal Business Name): MARLA MARIE SIMON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 W PIQUA CLAYTON RD
COVINGTON OH
45318-8802
US

IV. Provider business mailing address

7685 W PIQUA CLAYTON RD
COVINGTON OH
45318-8802
US

V. Phone/Fax

Practice location:
  • Phone: 937-473-2919
  • Fax: 937-473-2124
Mailing address:
  • Phone: 937-473-2919
  • Fax: 937-473-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN130747
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: