Basic Information
Provider Information
NPI: 1962472928
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STINEMAN
FirstName: MARSHA
MiddleName: RUTH
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 388
Address2:  
City: NEWTON
State: KS
PostalCode: 671140388
CountryCode: US
TelephoneNumber: 3162813700
FaxNumber: 3162824322
Practice Location
Address1: 750 AVE D WEST
Address2:  
City: KINGMAN
State: KS
PostalCode: 67068
CountryCode: US
TelephoneNumber: 6205323147
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/24/2006
LastUpdateDate: 05/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X54183KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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