Provider Demographics
NPI:1649363458
Name:MARSH, WINIFRED (CRNA)
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:
Last Name:MARSH
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 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7780
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112303367500000X
VA0024179575367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB136615OtherMEDICARE PIN GROUP # OA0369
TX83785UOtherBLUE CROSS BLUE SHIELD
TX1566366-06Medicaid
TX8941UBOtherBCBSTX GROUP 00C82U
TX89799UOtherBCBS
TX1566366-06Medicaid