Provider Demographics
NPI:1396711263
Name:STEVENS, MARLA JILL (CRNA)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:JILL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:JILL
Other - Last Name:FURJANIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 8500-8735
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-3289
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:TOWER 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN330865L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered