Healthcare Provider Details

I. General information

NPI: 1760472914
Provider Name (Legal Business Name): BRENT CASAD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E 11TH AVE
WINFIELD KS
67156-3716
US

IV. Provider business mailing address

709 E 11TH AVE
WINFIELD KS
67156-3716
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-6182
  • Fax: 620-221-2948
Mailing address:
  • Phone: 620-221-6182
  • Fax: 620-221-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54385
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: