Healthcare Provider Details

I. General information

NPI: 1013302470
Provider Name (Legal Business Name): CHRISTOPHER BRUSSEAU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH STREET ANESTHESIA DEPARTMENT
SIOUX FALLS SD
57117-5039
US

IV. Provider business mailing address

5701 S CHUCK DR
SIOUX FALLS SD
57108-2630
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-1225
  • Fax: 605-312-1226
Mailing address:
  • Phone: 605-376-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000875
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: