Basic Information
| Provider Information | |||||||||
| NPI: | 1336117886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANKE | ||||||||
| FirstName: | YVONNE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4046 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658084046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172695712 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | MONETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657081641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172353144 | ||||||||
| FaxNumber: | 4173541412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 063335 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 912798667 | 05 | MO | MEDICAID | 108602A | 01 | MO | BCBS | OTHER | 430057038 | 01 | RAILROAD MEDICARE | OTHER | 100376420A | 05 | KS | MEDICAID | 100786760A | 05 | OK | MEDICAID |