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NPI Code Detail

MEDICARE: BRUCE T WREATH CRNA

MEDICARE: BRUCE T WREATH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist24046IL

General Provider Information

NPI Number : 1841223823
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE T WREATH CRNA
Provider Business Mailing Address
First Line : 8213 NW 79TH TER
Second Line :
City : KANSAS CITY
State : MO
Zip : 64152-4206
Country : US
Telephone Number : 618-318-2350
Fax Number :
Provider Business Practice Location Address
First Line : 900 N WASHINGTON ST
Second Line :
City : DU QUOIN
State : IL
Zip : 62832-1230
Country : US
Telephone Number : 618-542-2146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/08/2007

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Directions to “ BRUCE T WREATH CRNA” Practice Location

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