Healthcare Provider Details

I. General information

NPI: 1740391440
Provider Name (Legal Business Name): NEAL BRUNKHORST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S WOODS MILL RD STE 140
CHESTERFIELD MO
63017-3427
US

IV. Provider business mailing address

400 S WOODS MILL RD STE 140
CHESTERFIELD MO
63017-3427
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-1101
  • Fax:
Mailing address:
  • Phone: 314-680-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124387
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: