Healthcare Provider Details

I. General information

NPI: 1730500414
Provider Name (Legal Business Name): BRENDAN WRYNN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 LOGAN DR SUITE 3
EVANSVILLE IN
47715-8238
US

IV. Provider business mailing address

PO BOX 41
MUNCIE IN
47308-0041
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-3937
  • Fax: 765-284-2434
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-284-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDAN WRYNN
Title or Position: OWNER/CRNA
Credential:
Phone: 812-230-0966