Provider Demographics
NPI:1972560530
Name:STARR, MARK A (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STARR
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 1:260 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2203
Mailing Address - Country:US
Mailing Address - Phone:608-643-3311
Mailing Address - Fax:
Practice Address - Street 1:260 26TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2203
Practice Address - Country:US
Practice Address - Phone:608-643-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78601367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430023952OtherRAILROAD MEDICARE
WI43290700Medicaid
000321160Medicare Oscar/Certification