Healthcare Provider Details

I. General information

NPI: 1215560552
Provider Name (Legal Business Name): BRADLEY RYAN KARPOWITZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 AUTOMATION WAY STE 103
FORT COLLINS CO
80525-5738
US

IV. Provider business mailing address

3720 LITTLE DIPPER DR
FORT COLLINS CO
80528-4447
US

V. Phone/Fax

Practice location:
  • Phone: 801-529-7409
  • Fax:
Mailing address:
  • Phone: 801-529-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8516620-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: