Individual
MARILYN MAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1602 SKIPWITH RD, RICHMOND, VA 23229-5205
(804) 208-9493
Mailing address
1602 SKIPWITH RD, RICHMOND, VA 23229-5205
(804) 289-4937
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024059725
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010087490
—
VA
Enumeration date
10/10/2005
Last updated
10/20/2014
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