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NPI Code Detail

MEDICARE: BRUCE R STOFIRA CRNA

MEDICARE: BRUCE R STOFIRA 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 Anesthetist28156265IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000300779OTHERINANTHEM BCBS

General Provider Information

NPI Number : 1952383051
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE R STOFIRA CRNA
Provider Business Mailing Address
First Line : 500 W VOTAW ST
Second Line :
City : PORTLAND
State : IN
Zip : 47371-1322
Country : US
Telephone Number : 260-726-7131
Fax Number : 260-726-1976
Provider Business Practice Location Address
First Line : 500 W VOTAW ST
Second Line :
City : PORTLAND
State : IN
Zip : 47371-1322
Country : US
Telephone Number : 260-726-7131
Fax Number : 260-726-1976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/09/2007

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Directions to “ BRUCE R STOFIRA CRNA” Practice Location

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