Provider Demographics
NPI:1396813739
Name:ECK, STEVEN (BSN, CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ECK
Suffix:
Gender:M
Credentials:BSN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 W LARSON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-1087
Mailing Address - Country:US
Mailing Address - Phone:641-842-4952
Mailing Address - Fax:
Practice Address - Street 1:2204 W LARSON ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-1087
Practice Address - Country:US
Practice Address - Phone:641-842-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065366367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265728Medicaid
IA26571Medicare ID - Type Unspecified