Healthcare Provider Details

I. General information

NPI: 1144467457
Provider Name (Legal Business Name): CHRISTOPHER T STAKE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 03/16/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHESHIRE MEDICAL CENTER 580 COURT STREET
KEENE NH
03431
US

IV. Provider business mailing address

30 OLDE ENGLISH RD
BEDFORD NH
03110-5619
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5400
  • Fax:
Mailing address:
  • Phone: 603-487-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041-309854
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: