Basic Information
| Provider Information | |||||||||
| NPI: | 1730500414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRENDAN WRYNN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NO PILL PAIN SERVICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41 | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473080041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652840493 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Practice Location | |||||||||
| Address1: | 6540 LOGAN DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477158238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124023937 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2013 | ||||||||
| LastUpdateDate: | 12/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | WRYNN | ||||||||
| AuthorizedOfficialFirstName: | BRENDAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/CRNA | ||||||||
| AuthorizedOfficialTelephone: | 8122300966 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.