Healthcare Provider Details

I. General information

NPI: 1053391391
Provider Name (Legal Business Name): BRENT JON PERSONS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SOUTHPOINTE CT STE 107
COLORADO SPRINGS CO
80906-3800
US

IV. Provider business mailing address

1330 QUAIL LAKE LOOP STE 220
COLORADO SPRINGS CO
80906-4651
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-6111
  • Fax: 877-247-9218
Mailing address:
  • Phone: 719-203-6111
  • Fax: 877-247-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0992305-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: