Healthcare Provider Details

I. General information

NPI: 1932176567
Provider Name (Legal Business Name): NANCY STULTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 NE HIGHWAY 103
WEIR KS
66781-4124
US

IV. Provider business mailing address

5419 NE HIGHWAY 103 PO BOX 276
WEIR KS
66781-4124
US

V. Phone/Fax

Practice location:
  • Phone: 620-396-8439
  • Fax:
Mailing address:
  • Phone: 620-396-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number117519
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: