Healthcare Provider Details

I. General information

NPI: 1265583512
Provider Name (Legal Business Name): BRADLEY SCOTT WERTZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 COUNTY ROAD Y
QUINTER KS
67752-6105
US

IV. Provider business mailing address

7211 COUNTY ROAD Y
QUINTER KS
67752-6105
US

V. Phone/Fax

Practice location:
  • Phone: 785-673-3242
  • Fax:
Mailing address:
  • Phone: 785-754-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54965
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: