Provider Demographics
NPI:1043800709
Name:GALVIN, BRIANNE NOEL (CRNA)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:NOEL
Last Name:GALVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:NOEL
Other - Last Name:BROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 HOUNDS RUN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-5431
Mailing Address - Country:US
Mailing Address - Phone:330-402-1189
Mailing Address - Fax:
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1111
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0020234367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered