Individual
MS. PAULA STORK
Active
Individual
MS. PAULA STORK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00177
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119778701
—
AR
01
—
430024522
RAILROAD MEDICARE
AR
01
—
59498
BLUE CROSS BLUE SHIELD AR
AR
Enumeration date
08/02/2005
Last updated
02/16/2010
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