Healthcare Provider Details

I. General information

NPI: 1972596245
Provider Name (Legal Business Name): MARY KATHLEEN MARKS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N BROAD STREET EXT
GROVE CITY PA
16127-4603
US

IV. Provider business mailing address

631 N BROAD STREET EXT
GROVE CITY PA
16127-4603
US

V. Phone/Fax

Practice location:
  • Phone: 724-450-7182
  • Fax: 724-450-7179
Mailing address:
  • Phone: 724-450-7182
  • Fax: 724-450-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN166950L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: