Provider Demographics
NPI:1982695680
Name:OJEDA, MARILYN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:OJEDA
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 1:3414 SHARON LN
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5768
Mailing Address - Country:US
Mailing Address - Phone:618-977-3878
Mailing Address - Fax:618-465-3105
Practice Address - Street 1:3414 SHARON LN
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5768
Practice Address - Country:US
Practice Address - Phone:618-977-3878
Practice Address - Fax:618-465-3105
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9184014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered