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NPI Code Detail

MEDICARE: MR. BRIAN NEAL STEPHENS CRNA

MEDICARE: MR. BRIAN NEAL STEPHENS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR0051118OK

General Provider Information

NPI Number : 1578566279
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN NEAL STEPHENS CRNA
Provider Business Mailing Address
First Line : 16625 E 120TH ST N
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-5853
Country : US
Telephone Number : 918-371-6606
Fax Number :
Provider Business Practice Location Address
First Line : 300 ROCKEFELLER DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-5075
Country : US
Telephone Number : 918-684-2279
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 10/08/2007

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