Healthcare Provider Details

I. General information

NPI: 1861444101
Provider Name (Legal Business Name): STEPHEN R SPIRES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S 10TH ST ELITE ANES. - CREDENTIALING
LEESVILLE LA
71446-4611
US

IV. Provider business mailing address

6000 BOCAGE DR
ALEXANDRIA LA
71303-2191
US

V. Phone/Fax

Practice location:
  • Phone: 337-392-5088
  • Fax: 337-392-4982
Mailing address:
  • Phone: 318-419-0756
  • Fax: 337-392-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN099590-AP04371
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: