Provider Demographics
NPI:1740391440
Name:BRUNKHORST, NEAL (CRNA)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:
Last Name:BRUNKHORST
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 1:400 S WOODS MILL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3427
Mailing Address - Country:US
Mailing Address - Phone:314-680-5370
Mailing Address - Fax:
Practice Address - Street 1:400 S WOODS MILL RD STE 140
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3427
Practice Address - Country:US
Practice Address - Phone:314-485-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001831367500000X
MO124387367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN