Healthcare Provider Details

I. General information

NPI: 1780359521
Provider Name (Legal Business Name): TROY JAMES STORER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 05/10/2026
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIOUX VALLEY DR
CHEROKEE IA
51012-1205
US

IV. Provider business mailing address

124 E MAIN ST
CHEROKEE IA
51012-1850
US

V. Phone/Fax

Practice location:
  • Phone: 712-225-5101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR32399
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD165062
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: