Healthcare Provider Details

I. General information

NPI: 1740782242
Provider Name (Legal Business Name): CHASE G HURTIG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 WHIPPLE ST
EAU CLAIRE WI
54703-5270
US

IV. Provider business mailing address

1101 W CLAIREMONT AVE STE 2C
EAU CLAIRE WI
54701-6161
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-3311
  • Fax:
Mailing address:
  • Phone: 715-834-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number239809-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: