Healthcare Provider Details

I. General information

NPI: 1558357111
Provider Name (Legal Business Name): BRIAN R. TRESTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 NORTHWINDS PKWY
ALPHARETTA GA
30009-2280
US

IV. Provider business mailing address

16 E BROOKHAVEN RD
WALLINGFORD PA
19086-6326
US

V. Phone/Fax

Practice location:
  • Phone: 877-742-0399
  • Fax: 678-352-4305
Mailing address:
  • Phone: 610-618-0167
  • Fax: 610-891-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN291595L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: