Provider Demographics
NPI:1790970432
Name:BRENDA CREITZ ANESTHESIA INC
Entity Type:Organization
Organization Name:BRENDA CREITZ ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:970-275-0492
Mailing Address - Street 1:PO BOX434
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0434
Mailing Address - Country:US
Mailing Address - Phone:970-275-0492
Mailing Address - Fax:
Practice Address - Street 1:112 W SPENCER AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2545
Practice Address - Country:US
Practice Address - Phone:970-641-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89727367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49731564Medicaid
COC810377Medicare PIN