Provider Demographics
NPI:1952632671
Name:WHITTINGTON, MARSHALL EVANS (CRNA)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:EVANS
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:131 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8522
Mailing Address - Country:US
Mailing Address - Phone:704-662-0876
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3550
Practice Address - Fax:570-476-3475
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2011-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN612338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered