Provider Demographics
NPI:1750366274
Name:DEAN, BRAD RUSSELL (CRNA)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:RUSSELL
Last Name:DEAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1408 SAND HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3810
Mailing Address - Country:US
Mailing Address - Phone:919-761-8660
Mailing Address - Fax:919-496-1622
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-585-1700
Practice Address - Fax:336-585-1771
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY520570-1367500000X
NC162885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY520570-1OtherLICENSE
NY520570-1OtherLICENSE
NC2619044CMedicare PIN