Provider Demographics
NPI:1215960380
Name:WRYNN, BRENDAN (CRNA)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:WRYNN
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 1:3507 N GRAND AVE APT 31
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3475
Mailing Address - Country:US
Mailing Address - Phone:765-827-7708
Mailing Address - Fax:765-827-7733
Practice Address - Street 1:1941 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2833
Practice Address - Country:US
Practice Address - Phone:765-827-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN293240L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered