Individual
STACY L THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R020320-0336
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0574533
—
IA
05
—
060963300
—
MN
01
—
1548272776
WELLMARK BCBS/TRICARE
SD
05
—
460224743-48
—
NE
01
—
460224743-57105-AC47
TRICARE PROV #
SD
05
—
5752002
—
SD
01
—
753S4OM
MN BLUE CROSS PROV #
MN
01
—
9213801
DAKOTACARE PROV #
SD
Enumeration date
08/13/2006
Last updated
07/19/2012
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