Provider Demographics
NPI:1548242506
Name:SMALLEY, MARILYN E (CRNA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:E
Last Name:SMALLEY
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 1:803 N BRADY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2115
Mailing Address - Country:US
Mailing Address - Phone:785-263-4765
Mailing Address - Fax:
Practice Address - Street 1:803 N BRADY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2115
Practice Address - Country:US
Practice Address - Phone:785-263-4765
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16537367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012026Medicare ID - Type Unspecified