Healthcare Provider Details

I. General information

NPI: 1275595126
Provider Name (Legal Business Name): RICHARD M HESTER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROUTE 3
DEDEDO GU
96929-6911
US

IV. Provider business mailing address

PO BOX 9016
TAMUNING GU
96931-5016
US

V. Phone/Fax

Practice location:
  • Phone: 671-645-5500
  • Fax:
Mailing address:
  • Phone: 671-683-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNP0190
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009317
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9335125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: