Provider Demographics
NPI:1255376422
Name:BRADE, WILLIAM E (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:BRADE
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 1:1505 LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3521
Mailing Address - Country:US
Mailing Address - Phone:816-525-9094
Mailing Address - Fax:
Practice Address - Street 1:100 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1554
Practice Address - Country:US
Practice Address - Phone:816-678-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146663367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918404203Medicaid
N70C821Medicare ID - Type Unspecified