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NPI Code Detail

MEDICARE: BRETT ROACH CRNA

MEDICARE: BRETT ROACH 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 Anesthetist139755MO

General Provider Information

NPI Number : 1851372023
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRETT ROACH CRNA
Provider Business Mailing Address
First Line : 13523 BARRETT PARKWAY DR
Second Line : SUITE 210
City : BALLWIN
State : MO
Zip : 63021-3802
Country : US
Telephone Number : 314-775-2816
Fax Number : 314-775-2821
Provider Business Practice Location Address
First Line : 300 1ST CAPITOL DR
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-2844
Country : US
Telephone Number : 314-989-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 07/08/2007

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