Provider Demographics
NPI:1386912376
Name:SKYE ANESTHESIA, A NURSING CORPORATION
Entity type:Organization
Organization Name:SKYE ANESTHESIA, A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:855-759-3633
Mailing Address - Street 1:1127 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4008
Mailing Address - Country:US
Mailing Address - Phone:855-759-3633
Mailing Address - Fax:855-759-3633
Practice Address - Street 1:1127 LOMA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4008
Practice Address - Country:US
Practice Address - Phone:855-759-3633
Practice Address - Fax:855-759-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty