Healthcare Provider Details

I. General information

NPI: 1245778455
Provider Name (Legal Business Name): BRETT A SKATTUM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date: 06/21/2021
Reactivation Date: 11/05/2021

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5141
US

IV. Provider business mailing address

2735 CLAPTON DR
COLORADO SPRINGS CO
80920-7240
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8641
  • Fax:
Mailing address:
  • Phone: 719-238-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01472
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: