Healthcare Provider Details

I. General information

NPI: 1942488580
Provider Name (Legal Business Name): BRENDA S. REYMANN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E NATIONAL AVE
BRAZIL IN
47834-2718
US

IV. Provider business mailing address

8840 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3129
US

V. Phone/Fax

Practice location:
  • Phone: 812-442-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number078916
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3005625
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28212645A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: