Provider Demographics
NPI:1679996037
Name:STARK, DANTRI (CRNA)
Entity type:Individual
Prefix:
First Name:DANTRI
Middle Name:
Last Name:STARK
Suffix:
Gender:F
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STE. 1B350K
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8182
Practice Address - Country:US
Practice Address - Phone:806-743-2981
Practice Address - Fax:806-743-2984
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756910163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse