Provider Demographics
NPI:1639184591
Name:DECAY, MARSHA MORRELL (CRNA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:MORRELL
Last Name:DECAY
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LYNDON B JOHNSON FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-233-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704236874367500000X
TX645156367500000X
TXAP108323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMD236874OtherBLUE CROSS OF MI
TX8259UCOtherBCBS
MI104493761Medicaid
TXPENDINGMedicaid
MIMD236874OtherBLUE CROSS OF MI
MIN24360219Medicare ID - Type Unspecified
TXTXB144384Medicare PIN