Healthcare Provider Details

I. General information

NPI: 1194149765
Provider Name (Legal Business Name): DANIEL L HUTHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 VEACH RD STE 3
OWENSBORO KY
42303-8800
US

IV. Provider business mailing address

2900 VEACH RD STE 3
OWENSBORO KY
42303-8800
US

V. Phone/Fax

Practice location:
  • Phone: 270-684-5005
  • Fax:
Mailing address:
  • Phone: 270-684-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3008517
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28165587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: