Provider Demographics
NPI:1790759322
Name:BRICKHOUSE, DONNA (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BRICKHOUSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3990
Mailing Address - Country:US
Mailing Address - Phone:252-261-9211
Mailing Address - Fax:252-261-4329
Practice Address - Street 1:5200 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3990
Practice Address - Country:US
Practice Address - Phone:252-261-9211
Practice Address - Fax:252-261-4329
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101925367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051453Medicaid
NC183751OtherMEDCOST
NC8051453Medicaid