Healthcare Provider Details

I. General information

NPI: 1245365592
Provider Name (Legal Business Name): CHARLES DENNIS STEELE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 WEST 18TH STREET
HERMANN MO
65041
US

IV. Provider business mailing address

509 WEST 18TH STREET
HERMANN MO
65041
US

V. Phone/Fax

Practice location:
  • Phone: 573-486-2191
  • Fax: 573-486-3743
Mailing address:
  • Phone: 573-486-2191
  • Fax: 573-486-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number056362
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: