Healthcare Provider Details

I. General information

NPI: 1336226026
Provider Name (Legal Business Name): RONALD R QUANSTROM C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MILL ST
NEODESHA KS
66757-1817
US

IV. Provider business mailing address

14430 600 RD
NEODESHA KS
66757-1893
US

V. Phone/Fax

Practice location:
  • Phone: 620-325-2611
  • Fax: 620-325-2907
Mailing address:
  • Phone: 620-325-3992
  • Fax: 620-325-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54446
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: