Provider Demographics
NPI:1164480299
Name:BRICKSON, DENISE L (CRNA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:BRICKSON
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 1:1680 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1008
Mailing Address - Country:US
Mailing Address - Phone:507-372-3800
Mailing Address - Fax:507-372-3806
Practice Address - Street 1:1680 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1008
Practice Address - Country:US
Practice Address - Phone:507-372-3800
Practice Address - Fax:507-372-3806
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-083572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28510OtherBLUE CROSS BLUE SHIELD
IA0226423Medicaid
IAP00057073OtherRAILROAD MEDICARE
IA0226423Medicaid
IA28510OtherBLUE CROSS BLUE SHIELD