Individual
MR. BRADLEY WIERDA
Active
Individual
MR. BRADLEY WIERDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
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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