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General NPI Number Information
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NPI Number | 1720398175
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Entity Type | Individual
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Provider Name | BENJAMIN L STAFFORD CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 80 HIGHLAND STREET
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City | LACONIA
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State | NH
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Zip | 03246-3235
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Country | US
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Telephone | 603-524-3211
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Fax | 660-826-4852
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | LACONIA
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State | NH
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Zip | 03247-0190
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Country | US
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Telephone | 603-524-3211
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Fax | 660-826-4852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 213865
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 065099-23
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License Number State | NH
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