Provider Demographics
NPI:1629121181
Name:TOWNSEND, MARGUERITA VAN BRAKEL (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITA
Middle Name:VAN BRAKEL
Last Name:TOWNSEND
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 1:215 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-7812
Mailing Address - Country:US
Mailing Address - Phone:270-924-0398
Mailing Address - Fax:270-924-9830
Practice Address - Street 1:215 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-7812
Practice Address - Country:US
Practice Address - Phone:270-924-0398
Practice Address - Fax:270-924-9830
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered