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General NPI Number Information
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NPI Number | 1295888196
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Entity Type | Individual
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Provider Name | PATRICIA HUSTON CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 5000 MEMORIAL DR
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City | TWO RIVERS
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State | WI
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Zip | 54241-3900
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Country | US
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Telephone | 920-686-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 W FOREST HOME AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2843
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Country | US
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Telephone |
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041-169888
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License Number State | IL
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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 | 209-003417
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3392
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License Number State | WI
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