Healthcare Provider Details

I. General information

NPI: 1376574467
Provider Name (Legal Business Name): DANIEL E O'KEEFE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

IV. Provider business mailing address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7480
  • Fax: 586-759-7479
Mailing address:
  • Phone: 586-759-7480
  • Fax: 586-759-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704125526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: