Provider Demographics
NPI:1134128473
Name:MARPLES, MARTHA JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:MARPLES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:HAIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1911 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6414
Mailing Address - Country:US
Mailing Address - Phone:620-225-1989
Mailing Address - Fax:
Practice Address - Street 1:100 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7216
Practice Address - Country:US
Practice Address - Phone:620-225-2847
Practice Address - Fax:620-225-7046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54420367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS015264Medicare ID - Type UnspecifiedKANSAS MEDICARE NUMBER