Individual
TYLER MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-6648
(505) 609-2259
Mailing address
2204 IRONWOOD PL, STE B, COEUR D ALENE, ID 83814-2662
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA-01419
NM
Other
Enumeration date
07/07/2016
Last updated
08/30/2017
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