Provider Demographics
NPI:1891708137
Name:ROTRAMEL, STUART L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:L
Last Name:ROTRAMEL
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 1:412 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993-1049
Mailing Address - Country:US
Mailing Address - Phone:765-762-4000
Mailing Address - Fax:
Practice Address - Street 1:412 N MONROE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993-1049
Practice Address - Country:US
Practice Address - Phone:765-762-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28156285A163W00000X, 367500000X
IL041-225933367500000X
IN41270367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209000436OtherCRNA LICENSE NUMBER
IN200854460Medicaid
IN000000976681OtherANTHEM PROVIDER NUMBER
ILR17931Medicare UPIN
IL204793Medicare PIN
IL209000436OtherCRNA LICENSE NUMBER
IN200854460Medicaid