Provider Demographics
NPI:1629362967
Name:CUMMINS, BRENT ADAM (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ADAM
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:823 SW MULVANE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1764
Mailing Address - Country:US
Mailing Address - Phone:785-235-3451
Mailing Address - Fax:785-235-1435
Practice Address - Street 1:823 SW MULVANE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1764
Practice Address - Country:US
Practice Address - Phone:785-235-3451
Practice Address - Fax:785-235-1435
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS13-96043-041163W00000X
KSTMP 143164367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse