Healthcare Provider Details

I. General information

NPI: 1336446038
Provider Name (Legal Business Name): NATHAN C STUMP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

3131 S DIXIE DR SUITE 535
MORAINE OH
45439-2256
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 937-297-6073
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN313564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: