Provider Demographics
NPI:1093387805
Name:MARSHALL, STACY ALLISON (CRNA, DNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ALLISON
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:ALLISON
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, DNP
Mailing Address - Street 1:2139 NATCHEZ TRCE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8306
Mailing Address - Country:US
Mailing Address - Phone:859-967-8387
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2489
Practice Address - Country:US
Practice Address - Phone:513-862-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered