Provider Demographics
NPI:1821030230
Name:ABERCROMBIE, STEPHEN HUGH (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HUGH
Last Name:ABERCROMBIE
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 1:1101 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5161
Mailing Address - Country:US
Mailing Address - Phone:406-455-5000
Mailing Address - Fax:
Practice Address - Street 1:1930 W BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1960
Practice Address - Country:US
Practice Address - Phone:406-541-6844
Practice Address - Fax:406-541-6843
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1821030230Medicaid
MT99446OtherBLUE CROSS BLUE SHIELD