Provider Demographics
NPI:1427795343
Name:MARSEE, JUSTIN (CRNA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MARSEE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-7659
Mailing Address - Country:US
Mailing Address - Phone:219-242-0364
Mailing Address - Fax:
Practice Address - Street 1:5209 WOODROW AVE
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-7659
Practice Address - Country:US
Practice Address - Phone:219-242-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28239850A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered