Provider Demographics
NPI:1376585471
Name:MARBLE, JOHN A (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MARBLE
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 1:100 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5520
Mailing Address - Country:US
Mailing Address - Phone:985-649-7070
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-641-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04648367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06122221Medicaid
LA04648OtherADVANCED PRACTICE
LA1320749Medicaid
LA098770OtherRN LICENSE
LA4H777CT29Medicare PIN
LA4H777Medicare PIN
LA4H777CT28Medicare PIN