=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649286444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH BRYAN SCHULZ CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RAPID CITY REGIONAL HOSPITAL 353 FAIRMONT BLVD
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-698-8751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4106 EAST COUNTRY FAIR DRIVE #B
-----------------------------------------------------
City | WASILLA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-698-8751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | R030901
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R030901/0452
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------