Provider Demographics
NPI:1093783979
Name:INNOCENT, MARIE PATRICIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:PATRICIA
Last Name:INNOCENT
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 1:309 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6455
Mailing Address - Country:US
Mailing Address - Phone:540-552-2938
Mailing Address - Fax:540-552-2938
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:301-816-7405
Practice Address - Fax:540-552-2938
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2055252367500000X
DEL6-0A10941367500000X
MDAC001376367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301921700Medicaid
FLG1979ZMedicare ID - Type Unspecified