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NPI Code Detail

MEDICARE: JOHN W STOMBAUGH CRNA

MEDICARE: JOHN W STOMBAUGH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR1364075MN
2367500000XCertified Registered Nurse AnesthetistWI

General Provider Information

NPI Number : 1518979194
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN W STOMBAUGH CRNA
Provider Business Mailing Address
First Line : 2107 HEIGHTS DR
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-6130
Country : US
Telephone Number : 715-834-8721
Fax Number :
Provider Business Practice Location Address
First Line : 2107 HEIGHTS DR
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-6130
Country : US
Telephone Number : 715-834-8721
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 07/31/2007

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Directions to “ JOHN W STOMBAUGH CRNA” Practice Location

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