Provider Demographics
NPI:1194892364
Name:HUETTE, RAYMOND E (CRNA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:HUETTE
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 1:230 WOODSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9663
Mailing Address - Country:US
Mailing Address - Phone:585-265-3072
Mailing Address - Fax:585-265-4405
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:STE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-261-2762
Practice Address - Fax:585-265-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345096367500000X
SC615367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R84793Medicare UPIN
SCQ359229110Medicare PIN
NYDD5665Medicare PIN