Provider Demographics
NPI:1144467457
Name:STAKE, CHRISTOPHER T (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:T
Last Name:STAKE
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 1:30 OLDE ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5619
Mailing Address - Country:US
Mailing Address - Phone:603-487-0777
Mailing Address - Fax:
Practice Address - Street 1:CHESHIRE MEDICAL CENTER
Practice Address - Street 2:580 COURT STREET
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-309854367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered