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NPI Code Detail

MEDICARE: RICHARD EDDY WATENPAUGH CRNA

MEDICARE: RICHARD EDDY WATENPAUGH 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
1367500000XCertified Registered Nurse Anesthetist54381KS

General Provider Information

NPI Number : 1992777205
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD EDDY WATENPAUGH CRNA
Provider Business Mailing Address
First Line : PO BOX 388
Second Line :
City : NEWTON
State : KS
Zip : 67114-0388
Country : US
Telephone Number : 316-281-3700
Fax Number : 316-282-4322
Provider Business Practice Location Address
First Line : 1701 E 23RD AVE
Second Line :
City : HUTCHINSON
State : KS
Zip : 67502-1105
Country : US
Telephone Number : 620-665-2000
Fax Number : 620-665-2288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/08/2007

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