Healthcare Provider Details

I. General information

NPI: 1386214500
Provider Name (Legal Business Name): BRENNA COTTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

IV. Provider business mailing address

1118 MONTCLAIRE DR NE
ALBUQUERQUE NM
87110-6130
US

V. Phone/Fax

Practice location:
  • Phone: 817-764-7769
  • Fax:
Mailing address:
  • Phone: 360-907-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number79688
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: