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General NPI Number Information
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NPI Number | 1851011852
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Entity Type | Individual
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Provider Name | MARISSA MULDER CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 9500 E IRONWOOD SQUARE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4582
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Country | US
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Telephone | 480-626-2552
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Fax | 482-626-2552
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Provider Business Mailing Address
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Address Line | 9259 W DENTON LN
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City | GLENDALE
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State | AZ
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Zip | 85305-3303
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Country | US
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Telephone | 916-955-4725
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Fax |
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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 | 280087
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License Number State | AZ
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