Healthcare Provider Details

I. General information

NPI: 1730433871
Provider Name (Legal Business Name): BRENT ANTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-9011
  • Fax:
Mailing address:
  • Phone: 808-538-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0894
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-1954
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: