Provider Demographics
NPI:1053391391
Name:PERSONS, BRENT JON (CRNA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JON
Last Name:PERSONS
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1330 QUAIL LAKE LOOP STE 220
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-203-6111
Mailing Address - Fax:877-247-9218
Practice Address - Street 1:630 SOUTHPOINTE CT STE 107
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3800
Practice Address - Country:US
Practice Address - Phone:719-203-6111
Practice Address - Fax:877-247-9218
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0992305-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered