Healthcare Provider Details

I. General information

NPI: 1962492116
Provider Name (Legal Business Name): STEVEN D NEWSOME CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/10/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 5TH AVE
WINFIELD KS
67156-2407
US

IV. Provider business mailing address

PO BOX 15
WINFIELD KS
67156-0015
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-2300
  • Fax: 620-221-9560
Mailing address:
  • Phone: 620-281-3700
  • Fax: 620-221-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54405
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: