Healthcare Provider Details

I. General information

NPI: 1306401914
Provider Name (Legal Business Name): CHASITY LYNN STAHL DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE
HOBART IN
46342-6638
US

IV. Provider business mailing address

12834 VAN BUREN ST
CROWN POINT IN
46307-9288
US

V. Phone/Fax

Practice location:
  • Phone: 219-310-5437
  • Fax:
Mailing address:
  • Phone: 219-310-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28175512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: