Healthcare Provider Details

I. General information

NPI: 1366003816
Provider Name (Legal Business Name): KATHERINE DAGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 W 5TH LN
HIALEAH FL
33012-3809
US

IV. Provider business mailing address

4135 W 5TH LN
HIALEAH FL
33012-3809
US

V. Phone/Fax

Practice location:
  • Phone: 786-384-4014
  • Fax:
Mailing address:
  • Phone: 786-384-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9377584
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11003191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: