Organization
MARBLE MOUNTAIN ANESTHESIA, INC., A PROFESSIONAL NURSING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON NICOLE DAVIDSON CRNA (PRESIDENT/CFO/SECRETARY)
(530) 240-5115
Entity
Organization
Contact information
Practice address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 841-6283
Mailing address
112 SERPA LN, FORT JONES, CA 96032-9734
(530) 240-5115
(530) 841-6286
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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