Provider Demographics
NPI:1811937956
Name:BROWN, MICHAEL C (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3045 S NATIONAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4247
Mailing Address - Country:US
Mailing Address - Phone:417-882-1900
Mailing Address - Fax:417-882-1966
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-882-1900
Practice Address - Fax:417-882-1966
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO082218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered