Provider Demographics
NPI:1649286444
Name:SCHULZ, KENNETH BRYAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRYAN
Last Name:SCHULZ
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 1:4106 EAST COUNTRY FAIR DRIVE #B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:406-698-8751
Mailing Address - Fax:
Practice Address - Street 1:RAPID CITY REGIONAL HOSPITAL
Practice Address - Street 2:353 FAIRMONT BLVD
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:406-698-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR030901163WG0000X
SDR030901/0452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered