Provider Demographics
NPI:1326071952
Name:STOCKMAN, REED (CRNA)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 E PRESTWICK RD
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-8910
Mailing Address - Country:US
Mailing Address - Phone:620-805-9063
Mailing Address - Fax:
Practice Address - Street 1:1004 PARKWAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9348
Practice Address - Country:US
Practice Address - Phone:574-522-9922
Practice Address - Fax:574-522-9926
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205706A367500000X
NMCRNA01006367500000X
AZ0242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00625387OtherRR MEDICARE GROUP CQ2302
KS200554540AMedicaid
KS110017006Medicare PIN
KS1326071952OtherBCBS