Healthcare Provider Details

I. General information

NPI: 1528332525
Provider Name (Legal Business Name): BRANDON KENT ALBRECHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 WOODCREST DRIVE
CHILLICOTHEE MO
64601
US

IV. Provider business mailing address

474 VALPARAISO CT
VALLEY PARK MO
63088-2320
US

V. Phone/Fax

Practice location:
  • Phone: 816-809-1261
  • Fax:
Mailing address:
  • Phone: 435-590-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2009015496
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: