Healthcare Provider Details

I. General information

NPI: 1740670686
Provider Name (Legal Business Name): RICHARD HORSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CONVERSE RD
MARION MA
02738-1669
US

IV. Provider business mailing address

110 MAIN ST
HYANNIS MA
02601-3145
US

V. Phone/Fax

Practice location:
  • Phone: 617-504-4213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN282797
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: