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Individual

BRANDON THOMAS STOUT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
475 W RIVER WOODS PKWY, GLENDALE, WI 53212-1081
(414) 961-6800
Mailing address
3872 E VAN NORMAN AVE, CUDAHY, WI 53110-1228
(414) 617-8160

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
220296-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
128013
WI

Other

Enumeration date
08/09/2019
Last updated
08/15/2024
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