Healthcare Provider Details

I. General information

NPI: 1154734036
Provider Name (Legal Business Name): BROOKE GEE BIRZES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 READS WAY
NEW CASTLE DE
19720-1607
US

IV. Provider business mailing address

123 NICHOLAS CT
NEW CASTLE DE
19720-5708
US

V. Phone/Fax

Practice location:
  • Phone: 302-709-4709
  • Fax: 302-709-4551
Mailing address:
  • Phone: 443-945-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL10036991
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: