Provider Demographics
NPI:1699751040
Name:OSWALD, MARK EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:OSWALD
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 1:24900 E ROXBURY PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4149
Mailing Address - Country:US
Mailing Address - Phone:303-690-1550
Mailing Address - Fax:303-690-0987
Practice Address - Street 1:24900 E ROXBURY PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4149
Practice Address - Country:US
Practice Address - Phone:303-690-1550
Practice Address - Fax:303-690-0987
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84034367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42978726Medicaid
CO42978726Medicaid
COC803110Medicare ID - Type Unspecified