Individual
STEPHEN G STUFFLEBAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2829
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2829
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
142461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RR MCR
MO
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
02/01/2007
Last updated
11/10/2015
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