Healthcare Provider Details

I. General information

NPI: 1508067810
Provider Name (Legal Business Name): DALE MICHAEL STEFFES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 6TH AVE SW
RONAN MT
59864-2634
US

IV. Provider business mailing address

PO BOX 759
POLSON MT
59860-0759
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-4441
  • Fax:
Mailing address:
  • Phone: 406-883-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number22172
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: