Provider Demographics
NPI:1043622715
Name:RODKEY, MARY EILEEN (RN, BSN, CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:EILEEN
Last Name:RODKEY
Suffix:
Gender:F
Credentials:RN, BSN, CRNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:EILEEN
Other - Last Name:ARTHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6761 CAMINO ROJO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3422
Mailing Address - Country:US
Mailing Address - Phone:412-445-7492
Mailing Address - Fax:
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-323-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-79511367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered