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General NPI Number Information
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NPI Number | 1205115268
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Entity Type | Individual
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Provider Name | LARRY LARUE MARSH CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 760 PILOT HOUSE DR SUITE B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2068
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Country | US
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Telephone | 757-591-2260
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Fax | 757-595-2001
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Provider Business Mailing Address
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Address Line | 804 SCOTT NIXON MEMORIAL DR
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City | AUGUSTA
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State | GA
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Zip | 30907-2464
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Country | US
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Telephone | 706-650-0705
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Fax | 706-650-1034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024169562
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License Number State | VA
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