MEDICARE: RICHARD JOSEPH KEPPLER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	046121	IA

General Provider Information

NPI Number	:	1962491142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEPH KEPPLER CRNA

Provider Business Mailing Address
First Line	:	11508 US HIGHWAY 52
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-8510
Country	:	US
Telephone Number	:	563-580-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	11508 HWY 52
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074
Country	:	US
Telephone Number	:	563-580-7366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	09/06/2013

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