Healthcare Provider Details

I. General information

NPI: 1760462022
Provider Name (Legal Business Name): BUENA VISTA ANESTHESIA ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 5TH ST
STORM LAKE IA
50588
US

IV. Provider business mailing address

207 STONEY POINT DR
STORM LAKE IA
50588
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-4030
  • Fax: 712-749-5114
Mailing address:
  • Phone: 712-732-8147
  • Fax: 712-749-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE M BINNING
Title or Position: CERTIFIED REGISTERED NURSE ANESTHET
Credential: CRNA
Phone: 712-732-8147