Healthcare Provider Details

I. General information

NPI: 1528042306
Provider Name (Legal Business Name): SUZANNE MICHELLE BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE B. HANSON CRNA

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

IV. Provider business mailing address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4855
  • Fax: 402-391-6818
Mailing address:
  • Phone: 402-391-4855
  • Fax: 402-391-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2005011883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: