Healthcare Provider Details

I. General information

NPI: 1114303237
Provider Name (Legal Business Name): BRYAN SCOTT FERRARA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
COLORADO SPRINGS CO
80913-4604
US

IV. Provider business mailing address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5231
  • Fax:
Mailing address:
  • Phone: 561-704-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRXN.0106147-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: