Provider Demographics
NPI:1689672560
Name:STELFLUG, BRADLEY WAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WAYNE
Last Name:STELFLUG
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 1:3790 N STATE ROAD 63
Mailing Address - Street 2:
Mailing Address - City:WEST TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47885-8407
Mailing Address - Country:US
Mailing Address - Phone:812-237-0211
Mailing Address - Fax:
Practice Address - Street 1:7 MEADOWS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2373
Practice Address - Country:US
Practice Address - Phone:812-237-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28159112A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484110Medicaid
IN200484110Medicaid
IN258290BMedicare PIN