Healthcare Provider Details

I. General information

NPI: 1710903554
Provider Name (Legal Business Name): DANIEL RICHARD MATTSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 AVENUE E
BILLINGS MT
59102-6548
US

IV. Provider business mailing address

3111 AVENUE E
BILLINGS MT
59102-6548
US

V. Phone/Fax

Practice location:
  • Phone: 406-490-3983
  • Fax:
Mailing address:
  • Phone: 406-490-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN28323
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: