Healthcare Provider Details

I. General information

NPI: 1326071952
Provider Name (Legal Business Name): REED STOCKMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PARKWAY AVE SUITE B
ELKHART IN
46516-9348
US

IV. Provider business mailing address

2830 E PRESTWICK RD
WINONA LAKE IN
46590-8910
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-9922
  • Fax: 574-522-9926
Mailing address:
  • Phone: 620-805-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28205706A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA01006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: