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General NPI Number Information
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NPI Number | 1831698299
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Entity Type | Individual
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Provider Name | JUSTIN STEVENSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 36053 EAGLE LN
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City | BEAUMONT
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State | CA
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Zip | 92223-8005
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Country | US
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Telephone | 801-598-6473
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Fax |
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Provider Business Mailing Address
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Address Line | 36053 EAGLE LN
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City | BEAUMONT
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State | CA
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Zip | 92223-8005
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Country | US
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Telephone | 801-598-6473
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Fax |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 95068824
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License Number State | CA
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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 | AP137237
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License Number State | TX
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