Basic Information
| Provider Information | |||||||||
| NPI: | 1477804060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STASCAVAGE | ||||||||
| FirstName: | NARDY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598729618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068224841 | ||||||||
| FaxNumber: | 4068224963 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598729618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068224841 | ||||||||
| FaxNumber: | 4068224963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2012 | ||||||||
| LastUpdateDate: | 09/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0800X | 9568 | MT | Y | Nursing Service Providers | Registered Nurse | Orthopedic | 207L00000X | 9568 | MT | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.