Provider Demographics
NPI:1780678821
Name:MARFLAK, CARMEN JEAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:JEAN
Last Name:MARFLAK
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 1:1709 ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6403
Mailing Address - Country:US
Mailing Address - Phone:843-525-0493
Mailing Address - Fax:843-525-6948
Practice Address - Street 1:1709 ACRES DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6403
Practice Address - Country:US
Practice Address - Phone:843-525-0493
Practice Address - Fax:843-525-6948
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN157388367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0233Medicaid
SCAN0233Medicaid
SCQ27375Medicare UPIN