Healthcare Provider Details

I. General information

NPI: 1376310151
Provider Name (Legal Business Name): STANLEY OWUSU DANSO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

IV. Provider business mailing address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

V. Phone/Fax

Practice location:
  • Phone: 541-882-6311
  • Fax:
Mailing address:
  • Phone: 541-882-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10035504
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: