Provider Demographics
NPI:1063476380
Name:HARROLD, MARILYN JANE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JANE
Last Name:HARROLD
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 1:2314 ROSEWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTH NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67117-0176
Mailing Address - Country:US
Mailing Address - Phone:316-282-4847
Mailing Address - Fax:
Practice Address - Street 1:2314 ROSEWOOD AVE.
Practice Address - Street 2:
Practice Address - City:NORTH NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67117-0176
Practice Address - Country:US
Practice Address - Phone:316-282-4847
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-20734-012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS144858OtherBLUE SHIELD