Provider Demographics
NPI:1407486012
Name:HUNTSMAN, NATHAN (CRNA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HUNTSMAN
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 1:654 N 840 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4270
Mailing Address - Country:US
Mailing Address - Phone:801-420-2730
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6065
Practice Address - Country:US
Practice Address - Phone:801-437-4500
Practice Address - Fax:801-437-1400
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8764516-3102163W00000X
UT8764516-8901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse