Healthcare Provider Details

I. General information

NPI: 1801893680
Provider Name (Legal Business Name): CRAIG W HUSTED CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD SUITE 305
UPLAND PA
19013-3955
US

IV. Provider business mailing address

2646 MAJESTIC DR
WILMINGTON DE
19810-2446
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-6448
  • Fax: 610-876-7399
Mailing address:
  • Phone: 302-475-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN221111L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: