Healthcare Provider Details

I. General information

NPI: 1043238405
Provider Name (Legal Business Name): STEVEN GASPER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CENTER AVE
MERRILL WI
54452-3404
US

IV. Provider business mailing address

9945 N 64TH AVE
MERRILL WI
54452-7507
US

V. Phone/Fax

Practice location:
  • Phone: 715-539-5136
  • Fax:
Mailing address:
  • Phone: 715-675-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number142133030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: