Provider Demographics
NPI:1265583512
Name:WERTZ, BRADLEY SCOTT (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:WERTZ
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 1:7211 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:QUINTER
Mailing Address - State:KS
Mailing Address - Zip Code:67752-6105
Mailing Address - Country:US
Mailing Address - Phone:785-754-3391
Mailing Address - Fax:
Practice Address - Street 1:7211 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:QUINTER
Practice Address - State:KS
Practice Address - Zip Code:67752-6105
Practice Address - Country:US
Practice Address - Phone:785-673-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54965367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered