Healthcare Provider Details

I. General information

NPI: 1124652177
Provider Name (Legal Business Name): DANIEL JOOST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

508 JACOB WAY APT 203
ROCHESTER MI
48307-6618
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704304325
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: