Provider Demographics
NPI:1780740639
Name:ROULE, MARENEA R (CRNA)
Entity type:Individual
Prefix:
First Name:MARENEA
Middle Name:R
Last Name:ROULE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARENEA
Other - Middle Name:A
Other - Last Name:ROULE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:6937 OLD QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9745
Mailing Address - Country:US
Mailing Address - Phone:315-214-5505
Mailing Address - Fax:
Practice Address - Street 1:6937 OLD QUARRY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9745
Practice Address - Country:US
Practice Address - Phone:315-214-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1195451367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered