Provider Demographics
NPI:1063263408
Name:FOULK, BRIANA L (CRNA)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:L
Last Name:FOULK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-0309
Mailing Address - Country:US
Mailing Address - Phone:712-213-4030
Mailing Address - Fax:
Practice Address - Street 1:1525 W 5TH ST OFC 1
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3027
Practice Address - Country:US
Practice Address - Phone:308-430-5025
Practice Address - Fax:712-749-5114
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD178808367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered