Healthcare Provider Details

I. General information

NPI: 1518120765
Provider Name (Legal Business Name): BRIAN JOHN ENGEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16818 E DESMET CT
SPOKANE VALLEY WA
99216-3542
US

IV. Provider business mailing address

427 S BERNARD STE 200 SPOKANE EYE SURGERY CTR
SPOKANE WA
99204-2509
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-5380
  • Fax:
Mailing address:
  • Phone: 509-456-8150
  • Fax: 509-455-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60025514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: