Provider Demographics
NPI:1821277542
Name:WHITMARSH, IAN (CRNA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:WHITMARSH
Suffix:
Gender:M
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 7389
Mailing Address - Street 2:ATTN: REBECCA EASON CPPA
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75607-7389
Mailing Address - Country:US
Mailing Address - Phone:888-260-6614
Mailing Address - Fax:903-257-0815
Practice Address - Street 1:1120 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4012
Practice Address - Country:US
Practice Address - Phone:918-579-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007888367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9655028Medicaid
WARN00123820OtherRN LICENSE
WAAP30007888OtherWA LICENSE NUMBER
OK0093190OtherREGISTERED NURSE/CRNA