Healthcare Provider Details

I. General information

NPI: 1366421778
Provider Name (Legal Business Name): HARRY STEWART CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 COMMUNITY DR
SENECA KS
66538-9739
US

IV. Provider business mailing address

1600 COMMUNITY DR
SENECA KS
66538-9739
US

V. Phone/Fax

Practice location:
  • Phone: 785-336-6181
  • Fax: 785-336-3052
Mailing address:
  • Phone: 785-336-6181
  • Fax: 785-336-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54365
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: