1689749376 NPI number — MR. NATHAN DOUGLAS CHESSHIR CRNA

Table of content: MR. NATHAN DOUGLAS CHESSHIR CRNA (NPI 1689749376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689749376 NPI number — MR. NATHAN DOUGLAS CHESSHIR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESSHIR
Provider First Name:
NATHAN
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHESSHIR
Provider Other First Name:
DOUG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.R.N.A.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689749376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808
Provider Second Line Business Mailing Address:
MUIRFIELD DR.
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
66520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-443-6737
Provider Business Mailing Address Fax Number:
573-815-2308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 N KEENE ST STE 107
Provider Second Line Business Practice Location Address:
BOONE SURGERY CENTER
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-6897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-386-9224
Provider Business Practice Location Address Fax Number:
636-386-7679
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  088585 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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