Individual
BRYAN KEITH BRODDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2610 N. WOODLAWN, WICHITA, KS 67220-2729
(316) 685-6236
(316) 858-2793
Mailing address
PO BOX 3374, WICHITA, KS 67201-3374
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1379895032
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
556905
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200622590A
—
KS
01
—
P00795820
RR MEDICARE GROUP CQ2302
KS
Enumeration date
06/02/2009
Last updated
10/12/2011
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