Healthcare Provider Details

I. General information

NPI: 1255666871
Provider Name (Legal Business Name): BRIAN DAVID HOLT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 2ND AVE
LATROBE PA
15650-1068
US

IV. Provider business mailing address

PO BOX 229
LATROBE PA
15650-0229
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1230
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax: 201-804-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN539685
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN539685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: