Individual
MR. STUART L. ROTRAMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
412 N MONROE ST, WILLIAMSPORT, IN 47993-1049
(765) 762-4000
Mailing address
412 N MONROE ST, WILLIAMSPORT, IN 47993-1049
(765) 762-4000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28156285A
IN
367500000X
Certified Registered Nurse Anesthetist
041-225933
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28156285A
IN
367500000X
Certified Registered Nurse Anesthetist
41270
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000976681
ANTHEM PROVIDER NUMBER
IN
05
—
200854460
—
IN
01
—
209000436
CRNA LICENSE NUMBER
IL
Enumeration date
08/15/2006
Last updated
05/16/2023
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