Provider Demographics
NPI:1619036175
Name:MARBLE, STEPHANIE GISELE (DNAP, CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GISELE
Last Name:MARBLE
Suffix:
Gender:F
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:GISELE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3646 WAITS RD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-6504
Mailing Address - Country:US
Mailing Address - Phone:315-396-6476
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076390367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB3440Medicare PIN