Healthcare Provider Details

I. General information

NPI: 1699760793
Provider Name (Legal Business Name): EARL D LOSEE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 SKAGGS RD
BRANSON MO
65616-2031
US

IV. Provider business mailing address

PO BOX 842120
KANSAS CITY MO
64184-2120
US

V. Phone/Fax

Practice location:
  • Phone: 800-277-8151
  • Fax:
Mailing address:
  • Phone: 417-239-3392
  • Fax: 417-239-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number095981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: