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General NPI Number Information
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NPI Number | 1225297724
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Entity Type | Individual
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Provider Name | TRACY HUNTINGTON CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 205 ORCHARD DR
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City | SISSETON
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State | SD
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Zip | 57262-2312
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Country | US
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Telephone | 605-698-4665
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Fax | 605-698-6401
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Provider Business Mailing Address
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Address Line | PO BOX 6001
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City | FARGO
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State | ND
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Zip | 58108-6001
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Country | US
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Telephone | 701-364-8000
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Fax | 701-364-8078
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR000703
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R30191
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License Number State | ND
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