Provider Demographics
NPI:1497730287
Name:KASEMAN, BRYAN T (CRNA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:T
Last Name:KASEMAN
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 1:10031 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4306
Mailing Address - Country:US
Mailing Address - Phone:602-614-1696
Mailing Address - Fax:
Practice Address - Street 1:10031 N 26TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4306
Practice Address - Country:US
Practice Address - Phone:602-614-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN101883367500000X
AZCRNA0183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ647133Medicaid
AZP00150757OtherRAILROAD MEDICARE
P52590Medicare UPIN
AZP00150757OtherRAILROAD MEDICARE
AZZ165850Medicare PIN