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General NPI Number Information
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NPI Number | 1518942507
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Entity Type | Individual
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Provider Name | RICHARD HUNTLEY C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1506 S ONEIDA ST
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City | APPLETON
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State | WI
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Zip | 54915-1305
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Country | US
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Telephone | 920-915-4624
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Fax |
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Provider Business Mailing Address
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Address Line | W5287 NATURES WAY DRIVE DRIVE
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City | SHERWOOD
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State | WI
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Zip | 54169
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Country | US
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Telephone | 920-915-4624
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 145985-030
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License Number State | WI
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