Provider Demographics
NPI:1003844705
Name:SESTOCK, MARILYN JUNE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JUNE
Last Name:SESTOCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 FRIENDSHIP AVE
Mailing Address - Street 2:#240
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1770
Mailing Address - Country:US
Mailing Address - Phone:412-235-5870
Mailing Address - Fax:
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:#240
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1770
Practice Address - Country:US
Practice Address - Phone:412-235-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN168870L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S62066Medicare UPIN