Healthcare Provider Details

I. General information

NPI: 1780164749
Provider Name (Legal Business Name): BRANDON NOEL KASBURG RN, MSN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

7700 PEACHMONT AVE NW APT 13
NORTH CANTON OH
44720-5739
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6000
  • Fax:
Mailing address:
  • Phone: 330-814-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: