Healthcare Provider Details

I. General information

NPI: 1164452330
Provider Name (Legal Business Name): BRUCE AUGUST CRAIG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 E SILVER SPUR LN
SPOKANE WA
99217-9737
US

IV. Provider business mailing address

PO BOX 94645
SEATTLE WA
98124-6945
US

V. Phone/Fax

Practice location:
  • Phone: 509-270-0822
  • Fax: 509-468-5264
Mailing address:
  • Phone: 509-474-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006844
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: