Provider Demographics
NPI:1306861935
Name:CHIAVACCI, MARJORIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:A
Last Name:CHIAVACCI
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 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-434-8806
Practice Address - Street 1:408 ROUTE 70 EAST
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:215-829-3867
Practice Address - Fax:215-829-5567
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN286751L367500000X
NJ26NR07942400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00614951OtherRAILROAD MEDICARE
PA50077109OtherCAPIITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE
PA50077109OtherCAPIITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE
PA030666Medicare PIN
NJ006403RVBMedicare PIN
PAP00614951OtherRAILROAD MEDICARE