| Marlene Mb Wallace, CRNA | |
|
5955 Zeamer Ave, 673rd Medical Group/sghq Dod-va Joint Venture Hospital, Jber, AK 99506-3702 | |
| (907) 580-1035 | |
| (907) 580-3203 |
| Full Name | Marlene Mb Wallace |
|---|---|
| Gender | Female |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 5955 Zeamer Ave, Jber, Alaska |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629037676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163WP0000X | Registered Nurse - Pain Management | 041305554 (Illinois) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 209012095 (Illinois) | Primary |
| Entity Name | North American Partners In Anesthesia Illinois Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1699032524 PECOS PAC ID: 1052576519 Enrollment ID: O20120706000534 |
| Mailing Address | Practice Location Address |
|---|---|
| Marlene Mb Wallace, CRNA 5955 Zeamer Ave, 673rd Medical Group/sghq Dod-va Joint Venture Hospital, Jber, AK 99506-3702 Ph: (907) 580-1035 | Marlene Mb Wallace, CRNA 5955 Zeamer Ave, 673rd Medical Group/sghq Dod-va Joint Venture Hospital, Jber, AK 99506-3702 Ph: (907) 580-1035 |
Christopher Cowley, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 5955 Zeamer Ave, 673 Mdg, Jber, AK 99506 Phone: 907-580-1815 | |
Daniel Thomas Perez, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 5955 Zeamer Ave, Jber, AK 99506 Phone: 907-580-1825 | |
Mr. David L Johnson, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 673 Mdg, 5955 Zeamer Avenue, Jber, AK 99506 Phone: 907-580-1815 | |
Carolyn N Lee, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 673 Mdg, 5955 Zeamer Avenue, Jber, AK 99506 Phone: 907-580-1815 | |
Dr. Thomas Guy Fevurly, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 5955 Zeamer Ave, 673d Mdg / Sgcs / Sgcj, Jber, AK 99506 Phone: 907-580-1815 Fax: 907-580-5524 | |
Teresa R Sellers, Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 5955 Zeamer Ave, 673 Mdg, Jber, AK 99506 Phone: 907-580-1815 | |
Emily Roark, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 5955 Zeamer Ave, Jber, AK 99506 Phone: 907-580-1825 |