Provider Demographics
NPI:1093796617
Name:RUTER, STEPHANIE S (CRNA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:S
Last Name:RUTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:S
Other - Last Name:SIBBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:12303 DEPAUL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-344-7049
Mailing Address - Fax:314-344-7073
Practice Address - Street 1:12303 DEPAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-7049
Practice Address - Fax:314-344-7073
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN126697163W00000X
MO126697367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO430077091OtherRAILROAD MEDICARE
MO915178602Medicaid
IL$$$$$$$$$001OtherIL DEPT OF PUBLIC AID
MO430077091OtherRAILROAD MEDICARE
MO120060145Medicare PIN