Healthcare Provider Details

I. General information

NPI: 1578517959
Provider Name (Legal Business Name): STEPHEN R KATZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MOUNTAIN VIEW ST
POWELL WY
82435-2212
US

IV. Provider business mailing address

777 AVENUE H
POWELL WY
82435-2260
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-2267
  • Fax: 307-754-7731
Mailing address:
  • Phone: 307-754-2267
  • Fax: 307-754-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4423A
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18607.366
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18607-0366
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: