Provider Demographics
NPI:1245778455
Name:SKATTUM, BRETT A (CRNA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:SKATTUM
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 1:2735 CLAPTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7240
Mailing Address - Country:US
Mailing Address - Phone:719-238-5226
Mailing Address - Fax:
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5141
Practice Address - Country:US
Practice Address - Phone:575-522-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2021-11-05
Deactivation Date:2021-06-21
Deactivation Code:
Reactivation Date:2021-11-05
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered