Healthcare Provider Details

I. General information

NPI: 1629385901
Provider Name (Legal Business Name): DAVID R STEPHENS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 8TH ST NE
MASSILLON OH
44646-8503
US

IV. Provider business mailing address

3373 COMMERCE PKWY STE 3
WOOSTER OH
44691-7130
US

V. Phone/Fax

Practice location:
  • Phone: 330-834-4788
  • Fax: 330-834-4789
Mailing address:
  • Phone: 330-439-4656
  • Fax: 330-601-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN327644
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: