Individual
PAUL D HUTSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8600 STATE ROUTE 91 STE 250, PEORIA, IL 61615-7831
(309) 692-5393
(309) 692-2538
Mailing address
8600 STATE ROUTE 91 STE 250, PEORIA, IL 61615-7831
(309) 692-5393
(309) 692-2538
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-014114
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125929701
—
AR
01
—
175118
MO BLUE SHIELD
MO
05
—
912753506
—
MO
01
—
98333
ARK BLUE SHIELD
AR
Enumeration date
01/31/2007
Last updated
04/12/2016
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