Provider Demographics
NPI:1841381589
Name:DEVANEY, STEPHEN S (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:DEVANEY
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 1:228 PALANCAR AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-345-2623
Practice Address - Fax:507-389-4685
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR165907-8367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN083G5DEOtherBLUE CROSS BLUE SHIELD
2002418OtherMEDICA
132311OtherUCARE
HP57708OtherHEALTH PARTNERS
967551041127OtherPREFERRED ONE
132311OtherUCARE