Provider Demographics
NPI:1043556442
Name:MARKO, PENNIE MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:MARIE
Last Name:MARKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:PENNIE
Other - Middle Name:MARIE
Other - Last Name:OSANTOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2025 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1703
Mailing Address - Country:US
Mailing Address - Phone:586-292-2943
Mailing Address - Fax:
Practice Address - Street 1:2025 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1703
Practice Address - Country:US
Practice Address - Phone:586-292-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266251163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse