Individual
JEFFREY STORMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
20 MEDICAL VILLAGE DR, STE 258, EDGEWOOD, KY 41017-5401
(859) 341-2666
(859) 341-7867
Mailing address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2000
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1028649
KY
163W00000X
Registered Nurse
154045
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
023081
KY
367500000X
Certified Registered Nurse Anesthetist
NA00804
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000537064
ANTHEM
—
05
—
200877890
—
IN
05
—
2076159
—
OH
05
—
74001116
—
KY
01
—
9130423
PHCS
—
Enumeration date
12/13/2005
Last updated
09/16/2016
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