Healthcare Provider Details

I. General information

NPI: 1932282001
Provider Name (Legal Business Name): MARNI JILL CLYMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARNI JILL KLEIN CRNA

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3867
  • Fax: 215-829-5567
Mailing address:
  • Phone: 706-650-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number553363
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: