Provider Demographics
NPI:1780924118
Name:BLAZEK, BRADY N (CRNA, DNP)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:N
Last Name:BLAZEK
Suffix:
Gender:M
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17893 224TH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-8629
Mailing Address - Country:US
Mailing Address - Phone:563-920-0200
Mailing Address - Fax:
Practice Address - Street 1:17893 224TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-8629
Practice Address - Country:US
Practice Address - Phone:563-920-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116604390200000X
IAD116604367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program