Individual
MR. BENJAMIN WADE BRUESTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3325 POCAHONTAS RD, BAKER CITY, OR 97814-1464
(541) 523-1797
(541) 523-1799
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
004000
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
10005021
OR
Other
Enumeration date
02/26/2009
Last updated
03/09/2023
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