Healthcare Provider Details

I. General information

NPI: 1053563486
Provider Name (Legal Business Name): STEFAN KESLER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E 19TH ST
ROSWELL NM
88201
US

IV. Provider business mailing address

PO BOX 3622
ROSWELL NM
88202-3622
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-7000
  • Fax:
Mailing address:
  • Phone: 575-624-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEFAN KESLER
Title or Position: OWNER
Credential: CRNA
Phone: 575-624-2095