Healthcare Provider Details

I. General information

NPI: 1821027392
Provider Name (Legal Business Name): SCOTT M. BAINBRIDGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI ST SUITE 300
DUBUQUE IA
52001-6320
US

IV. Provider business mailing address

1515 DELHI ST SUITE 300
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-8500
  • Fax: 563-589-4078
Mailing address:
  • Phone: 563-557-8500
  • Fax: 563-589-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number087971
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: