Healthcare Provider Details

I. General information

NPI: 1093881906
Provider Name (Legal Business Name): SUSAN MARIE BRUENING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUMMIT ST
YANKTON SD
57078-3855
US

IV. Provider business mailing address

89787 563 AVE
SAINT HELENA NE
68774-7404
US

V. Phone/Fax

Practice location:
  • Phone: 605-668-8000
  • Fax: 605-668-8129
Mailing address:
  • Phone: 402-357-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100610
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: