Healthcare Provider Details

I. General information

NPI: 1700428885
Provider Name (Legal Business Name): BRENDON IGNATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL WAY
BUTLER PA
16001-4670
US

IV. Provider business mailing address

PO BOX 737
EAST BUTLER PA
16029-0737
US

V. Phone/Fax

Practice location:
  • Phone: 724-283-6666
  • Fax:
Mailing address:
  • Phone: 724-256-9700
  • Fax: 724-256-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number130148
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: