Provider Demographics
NPI:1366484495
Name:PARSONS, MARK J (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:PARSONS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2447
Mailing Address - Country:US
Mailing Address - Phone:720-494-9325
Mailing Address - Fax:720-494-9325
Practice Address - Street 1:1532 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2447
Practice Address - Country:US
Practice Address - Phone:720-494-9325
Practice Address - Fax:720-494-9325
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99928367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46527231Medicaid
CO46527231Medicaid