Provider Demographics
NPI:1063417160
Name:SPREEN, BARRY (CRNA)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SPREEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:112 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1022
Practice Address - Country:US
Practice Address - Phone:319-422-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA049809367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0266163Medicaid
IA430019359OtherRAILROAD MEDICARE
IA31547OtherBLUE CROSS OF IOWA
IA8501OtherMIDLANDS CHOICE
IA26616OtherBLUE CROSS BLUE SHIELD
MN19G74BAOtherBLUE CROSS OF MINNESOTA
IA8501OtherMIDLANDS CHOICE