Healthcare Provider Details

I. General information

NPI: 1487615357
Provider Name (Legal Business Name): BARRY R RICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66649 305TH ST
LITCHFIELD MN
55355-4803
US

IV. Provider business mailing address

66649 305TH ST
LITCHFIELD MN
55355-4803
US

V. Phone/Fax

Practice location:
  • Phone: 763-656-9001
  • Fax:
Mailing address:
  • Phone: 763-656-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2947
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number612498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: