Healthcare Provider Details

I. General information

NPI: 1619036175
Provider Name (Legal Business Name): STEPHANIE GISELE MARBLE DNAP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE GISELE RUSSELL

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

3646 WAITS RD
OWEGO NY
13827-6504
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-5564
  • Fax:
Mailing address:
  • Phone: 315-396-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number076390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: