Healthcare Provider Details

I. General information

NPI: 1154955854
Provider Name (Legal Business Name): BRYNNE E RADEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRYNNE E RADEL

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

6 SABIN ST
PUTNAM CT
06260-1842
US

V. Phone/Fax

Practice location:
  • Phone: 860-933-6903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127780
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: