Healthcare Provider Details

I. General information

NPI: 1467418368
Provider Name (Legal Business Name): BRENT THOMAS KAPFER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

IV. Provider business mailing address

10513 STONEBRIDGE TRL N
STILLWATER MN
55082-9569
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-7239
  • Fax:
Mailing address:
  • Phone: 612-382-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1350160
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4255
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: