Provider Demographics
NPI:1598724833
Name:TRUSSLER, STEPHANIE LEILANI (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEILANI
Last Name:TRUSSLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEILANI
Other - Last Name:SAJULGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3930
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3930
Mailing Address - Country:US
Mailing Address - Phone:417-347-4686
Mailing Address - Fax:417-347-6636
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-4686
Practice Address - Fax:417-347-6636
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062957367500000X
MO2001031005367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered