Provider Demographics
NPI:1871604868
Name:KAUFMANN, BRAD R (CRNA)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:R
Last Name:KAUFMANN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 STATE ROUTE 91 STE 250
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7831
Mailing Address - Country:US
Mailing Address - Phone:309-692-5394
Mailing Address - Fax:309-692-2538
Practice Address - Street 1:8600 STATE ROUTE 91 STE 250
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7831
Practice Address - Country:US
Practice Address - Phone:309-692-5394
Practice Address - Fax:309-692-2538
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041321305367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered