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General NPI Number Information
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NPI Number | 1326311572
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Entity Type | Individual
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Provider Name | JACOB MERRILL HUNSAKER CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 750 W 800 N
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City | OREM
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State | UT
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Zip | 84057-3660
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Country | US
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Telephone | 801-714-6000
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Fax | 801-733-5618
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Provider Business Mailing Address
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Address Line | PO BOX 3570
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City | SALT LAKE CITY
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State | UT
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Zip | 84110-3570
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Country | US
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Telephone | 801-432-2648
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Fax | 801-838-7105
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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 | 6483143-4406
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License Number State | UT
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