Provider Demographics
NPI:1982755583
Name:MUNSTER, RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MUNSTER
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 1:2108 KOHLER MEMORIAL DR
Mailing Address - Street 2:#101
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3100
Mailing Address - Country:US
Mailing Address - Phone:920-451-8142
Mailing Address - Fax:
Practice Address - Street 1:277 ALTENHOFEN DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8401
Practice Address - Country:US
Practice Address - Phone:815-633-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77189367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21658Medicare ID - Type Unspecified