Healthcare Provider Details

I. General information

NPI: 1790006542
Provider Name (Legal Business Name): STEPHEN P ST.GERMAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

8166 MAIN ST
HOUMA LA
70360-3404
US

V. Phone/Fax

Practice location:
  • Phone: 985-803-0290
  • Fax:
Mailing address:
  • Phone: 985-803-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR878585
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA213056
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: