Provider Demographics
NPI:1578109724
Name:HUNTER, WAYNE DUPREE JR
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:DUPREE
Last Name:HUNTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 PENN CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-1474
Mailing Address - Country:US
Mailing Address - Phone:916-588-7464
Mailing Address - Fax:
Practice Address - Street 1:424 PENN CENTRAL CT
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-1474
Practice Address - Country:US
Practice Address - Phone:916-588-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)