Healthcare Provider Details

I. General information

NPI: 1528046042
Provider Name (Legal Business Name): DUANE A SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 COLLEGE AVE
MANHATTAN KS
66502-3381
US

IV. Provider business mailing address

1228 WESTLOOP PL # 195
MANHATTAN KS
66502-2840
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-3320
  • Fax:
Mailing address:
  • Phone: 785-537-9930
  • Fax: 785-539-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55110
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: