Provider Demographics
NPI:1962680512
Name:BOYER, BRYAN S (CRNA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:BOYER
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 10TH ST E
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:1861 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-718-2000
Practice Address - Fax:717-718-3460
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN546242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3429152000OtherINDEPENDENCE BLUE CROSS
PA50075158OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA002014777OtherHIGHMARK
PAP00467179OtherRR MEDICARE
PA122385Medicare PIN