Provider Demographics
NPI:1639107220
Name:LOVENGUTH, MARLENE LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:LOUISE
Last Name:LOVENGUTH
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 1:94220 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-7756
Mailing Address - Country:US
Mailing Address - Phone:541-247-3000
Mailing Address - Fax:541-247-3151
Practice Address - Street 1:4921 E BELL RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-787-9100
Practice Address - Fax:602-508-4830
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR082012257CRNA367500000X
AZ228702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201074OtherDMAP
ORR0000ZGBDGOtherCURRY GENERAL HOSPITAL MEDICARE PART B
OR381322OtherCURRY GENERAL HOSPITAL'S MEDICARE PART A
R12212Medicare UPIN
ORR160203Medicare PIN