Provider Demographics
NPI:1912915182
Name:BRISBIN, CLAUDIA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JEAN
Last Name:BRISBIN
Suffix:
Gender:F
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:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0390
Mailing Address - Country:US
Mailing Address - Phone:541-561-1955
Mailing Address - Fax:
Practice Address - Street 1:1830 BLANKENSHIP RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4179
Practice Address - Country:US
Practice Address - Phone:503-655-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20056004CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered