Provider Demographics
NPI:1124109517
Name:GUNNELLS, STEVEN HENRY (CRNA, APRN)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:HENRY
Last Name:GUNNELLS
Suffix:
Gender:M
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 LINDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434
Mailing Address - Country:US
Mailing Address - Phone:785-742-2131
Mailing Address - Fax:785-742-6588
Practice Address - Street 1:300 UTAH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2314
Practice Address - Country:US
Practice Address - Phone:785-742-2131
Practice Address - Fax:785-742-6588
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4355160363L00000X
KS55160367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200254840BMedicaid
KS200254840BMedicaid