Provider Demographics
NPI:1568795904
Name:ROSENTHAL, STEPHANIE R (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3151
Mailing Address - Country:US
Mailing Address - Phone:518-495-6232
Mailing Address - Fax:
Practice Address - Street 1:6350 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4264
Practice Address - Country:US
Practice Address - Phone:307-232-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY49284367500000X
NY406037367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400007896Medicare PIN