Provider Demographics
NPI:1275564049
Name:STANTON, JOSEPH DAVID (CRNA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:STANTON
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 1:240 MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6200
Mailing Address - Country:US
Mailing Address - Phone:605-348-7607
Mailing Address - Fax:605-348-6146
Practice Address - Street 1:240 MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6200
Practice Address - Country:US
Practice Address - Phone:605-348-7607
Practice Address - Fax:605-348-6146
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR014733367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5752193Medicaid
SD5752193Medicaid