Healthcare Provider Details

I. General information

NPI: 1174508964
Provider Name (Legal Business Name): DAN H BRANON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 SUNSET DR SUITE 4
JOHNSON CITY TN
37604-2969
US

IV. Provider business mailing address

PO BOX 3727
JOHNSON CITY TN
37602-3727
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-0776
  • Fax: 423-283-0549
Mailing address:
  • Phone: 423-283-0776
  • Fax: 423-283-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009120
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: