Marble Mountain Anesthesia, Inc., a Professional Nursing Corporation

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

MARBLE MOUNTAIN ANESTHESIA, INC., A PROFESSIONAL NURSING CORPORATION

Practice address

444 Bruce St
Yreka, CA 96097-3450

Phone

(530) 841-6283

NPI assigned

Nov 14, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon Nicole Davidson, CRNA

Title

President/Cfo/Secretary

Phone

(530) 240-5115

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1922577535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 SERPA LN",
            "city": "FORT JONES",
            "state": "CA",
            "postal_code": "960329734",
            "telephone_number": "530-240-5115",
            "fax_number": "530-841-6286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973450",
            "telephone_number": "530-841-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARBLE MOUNTAIN ANESTHESIA, INC., A PROFESSIONAL NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT/CFO/SECRETARY",
        "authorized_official_telephone_number": "530-240-5115",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D Maloney, MD
• Susan Malony, MS, RD
• Judith Diane Manfredi, MS, LMFT
• Evelyn Stephanie Mann-Wilder, LCSW
• Seamus Mannix
• Chelsy Marriott, CD(DONA)
• David Earl Marriott, MD
• Daniel Marshall
• Aubry Martin
• Martinez Vamc

• Certified Registered Nurse Anesthetist in Yreka, CA
• Providers in Yreka, CA by specialty
• Certified Registered Nurse Anesthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.