Walter R Fetterley II, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RNA-619 Issued in ID

Practice address

621 Reserve St
Boise, ID 83712-6354

Phone

(208) 559-7162

NPI assigned

Aug 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bend Anesthesiology Group, PC

  • Anesthesiology Physician
  • Bend, OR
  • NPI 1467400200
  NPD
• Anesthesia Associates of Boise, P.a.

  • Specialist
  • Boise, ID
  • NPI 1033147467
  NPD (past)
• New Mexico Anesthesia Specialists LLC

  • Certified Registered Nurse Anesthetist
  • Alamogordo, NM
  • NPI 1629390083

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Roswell Clinic Corp

  • Family Medicine Physician
  • Roswell, NM
  • NPI 1649267618
  NPD (past)
• Saint Alphonsus Medical Center Baker City, Inc

  • Family Medicine Physician
  • Baker City, OR
  • NPI 1881726206

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Wa Spok DH Crna LLC

  • Certified Registered Nurse Anesthetist
  • Spokane, WA
  • NPI 1366692766

  Nurse Anesthetist, Certified Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227139200000",
    "number": "1891803482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 RESERVE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126354",
            "telephone_number": "208-559-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 RESERVE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126354",
            "telephone_number": "208-559-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTERLEY",
        "first_name": "WALTER",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2008-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807168100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200576850A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Ferro, DO
• Mary Claire Fery, LPC
• Alexandra Noel Fesperman, LMSW
• Kathryn M Fethke, M.D.
• Matthew G. Fethke, D.D.S.
• Laura Cathleen Fetters, LMSW
• Joseph Patrick Fetzek, M.D.
• Martha Fetzer, LCSW, RD, LD
• Ethan Feuerborn, D.O.
• Taylor Feuz, DPT

• Certified Registered Nurse Anesthetist in Boise, ID
• Providers in Boise, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.