Healthcare Provider Details

I. General information

NPI: 1427014331
Provider Name (Legal Business Name): STEPHANIE LYNN PRESTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S 9TH ST
LAFAYETTE IN
47905-5545
US

IV. Provider business mailing address

811 S 9TH ST
LAFAYETTE IN
47905-5545
US

V. Phone/Fax

Practice location:
  • Phone: 765-742-4950
  • Fax:
Mailing address:
  • Phone: 765-742-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28140106A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number019755
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209014268
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704239128
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9485336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: