Provider Demographics
NPI:1033149133
Name:HUETHER, DAVID MARK (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:HUETHER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17893 224TH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-8629
Mailing Address - Country:US
Mailing Address - Phone:563-927-6183
Mailing Address - Fax:563-927-6183
Practice Address - Street 1:17893 224TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-8629
Practice Address - Country:US
Practice Address - Phone:563-927-6183
Practice Address - Fax:563-927-6183
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-058058367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43747OtherVINTON BC/BS IOWA
IA4299990Medicaid
IA53700OtherINDE BC/BS IOWA
IA35069OtherSUMNER BC/BS IOWA
IA8299990Medicaid
IA10107OtherRMC BC/BS IOWA
IA7299990Medicaid
IA0299990Medicaid
IA43747OtherVINTON BC/BS IOWA
IA8299990Medicaid
IAR81053Medicare UPIN
IA0299990Medicaid