Individual
MR. BRADLEY WIERDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2710 RIFE MEDICAL LANE, ANESTHESIA DEPT, ROGERS, AR 72758-1452
(479) 338-8000
(479) 338-3056
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(913) 647-4100
(913) 647-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02770
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770560518
—
MO
05
—
179913001
—
AR
05
—
200347410A
—
OK
01
—
5V232
BCBSAR
AR
01
—
P00755473
RR
AR
Enumeration date
12/22/2005
Last updated
06/18/2021
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