Healthcare Provider Details

I. General information

NPI: 1972596468
Provider Name (Legal Business Name): DUANE L FUERST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 SHAWNEE RD
LIMA OH
45806-1444
US

IV. Provider business mailing address

1017 MAXINE LN SUITE 207
VAN WERT OH
45891-2649
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-8209
  • Fax:
Mailing address:
  • Phone: 419-238-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN147379
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number33934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: