Healthcare Provider Details

I. General information

NPI: 1841434842
Provider Name (Legal Business Name): BRADLEY S LARSEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 8TH ST SUITE 221
SIOUX FALLS SD
57103-7011
US

IV. Provider business mailing address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

V. Phone/Fax

Practice location:
  • Phone: 605-339-6525
  • Fax: 605-339-2905
Mailing address:
  • Phone: 605-339-6525
  • Fax: 605-339-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000749
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: