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RUSSELL STAGG CRNA
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1720356496
Individual Registrant: RUSSELL STAGG CRNA
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
100 PMC DR MEEKER, CO 81641-3181 US
Tel: 970-878-9740 Fax: --
Tel: 970-878-9740 Fax: --
Contact information for business:
PO BOX 2541 MEEKER, CO 81641-2541 US
Tel: 801-803-3106 Fax: --
Tel: 801-803-3106 Fax: --
Registration Information:
NPI: 1720356496
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 163W00000X | Nursing Service Providers Registered Nurse | UT | 6154226-3102 |
| Y | 367500000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered | MO | 2012001556 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
