Provider Demographics
NPI:1427323377
Name:FUSTER, NATHANIEL C (CRNA)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:C
Last Name:FUSTER
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 1:34 ROBERTSON DR
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6624
Mailing Address - Country:US
Mailing Address - Phone:305-492-9672
Mailing Address - Fax:
Practice Address - Street 1:34 ROBERTSON DR
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6624
Practice Address - Country:US
Practice Address - Phone:305-492-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-11
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065493-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered