Healthcare Provider Details

I. General information

NPI: 1093822637
Provider Name (Legal Business Name): WAYNE E BERKBIGLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 STATE HIGHWAY 248 SUITE B
BRANSON MO
65616-8003
US

IV. Provider business mailing address

1724 HILL HAVEN RD
HOLLISTER MO
65672-4833
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-8572
  • Fax: 417-335-8573
Mailing address:
  • Phone: 417-336-3662
  • Fax: 417-334-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number049094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: