Provider Demographics
NPI:1689630543
Name:SAGE, MARILIE KAY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARILIE
Middle Name:KAY
Last Name:SAGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4709A EXCALIBUR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1201
Mailing Address - Country:US
Mailing Address - Phone:915-526-3697
Mailing Address - Fax:915-542-3937
Practice Address - Street 1:4709A EXCALIBUR DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1201
Practice Address - Country:US
Practice Address - Phone:915-526-3697
Practice Address - Fax:915-542-3937
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX644538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered