Provider Demographics
NPI:1679677264
Name:ANDREGG, BRUCE C (CRNA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:ANDREGG
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:PO BOX 8485
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0485
Mailing Address - Country:US
Mailing Address - Phone:509-991-6992
Mailing Address - Fax:509-228-9542
Practice Address - Street 1:535 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1347
Practice Address - Country:US
Practice Address - Phone:509-623-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001974367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911697924OtherTAX ID
WA9615964Medicaid
WA319207301Medicare ID - Type Unspecified