Healthcare Provider Details

I. General information

NPI: 1386135143
Provider Name (Legal Business Name): BRITTANI NEELY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 ANAMARIA DR
RAPID CITY SD
57701-7366
US

IV. Provider business mailing address

2871 BELGARDE BLVD APT 106
RAPID CITY SD
57702-9793
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-4708
  • Fax:
Mailing address:
  • Phone: 605-210-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000990
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: