=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366421778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRY STEWART CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 10/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 COMMUNITY DR
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66538-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-336-6181
-----------------------------------------------------
Fax | 785-336-3052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 COMMUNITY DR
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66538-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-336-6181
-----------------------------------------------------
Fax | 785-336-3052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 54365
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------