Healthcare Provider Details

I. General information

NPI: 1821391228
Provider Name (Legal Business Name): GEORGE FRANK BRINIUS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVE
WAKEFIELD RI
02879-4216
US

IV. Provider business mailing address

11 WARNER PL
NEWPORT RI
02840-2150
US

V. Phone/Fax

Practice location:
  • Phone: 410-782-8000
  • Fax:
Mailing address:
  • Phone: 860-796-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN246325
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4569
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: