Provider Demographics
NPI:1558688960
Name:STURM, RUSSELL DUNCAN (CRNA)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DUNCAN
Last Name:STURM
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 1:11845 SW 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8516
Mailing Address - Country:US
Mailing Address - Phone:786-256-0998
Mailing Address - Fax:
Practice Address - Street 1:11845 SW 99TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8516
Practice Address - Country:US
Practice Address - Phone:786-256-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9175721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered