Healthcare Provider Details

I. General information

NPI: 1477609253
Provider Name (Legal Business Name): BRIAN CHRISTOPHER PELKEY C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 FOX GLEN DR APT 143
SAGINAW MI
48638-4314
US

IV. Provider business mailing address

6230 FOX GLEN DR APT 143
SAGINAW MI
48638-4314
US

V. Phone/Fax

Practice location:
  • Phone: 412-760-2236
  • Fax:
Mailing address:
  • Phone: 412-760-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704249405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: