Individual
RUSSELL STAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 PMC DR, MEEKER, CO 81641-3181
(970) 878-9740
Mailing address
PO BOX 2541, MEEKER, CO 81641-2541
(801) 803-3106
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
6154226-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
2012001556
MO
Other
Enumeration date
12/08/2011
Last updated
02/02/2021
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