Healthcare Provider Details

I. General information

NPI: 1225048259
Provider Name (Legal Business Name): DANIEL LINN BOOTEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 MANSON PIKE
MURFREESBORO TN
37129-3722
US

IV. Provider business mailing address

4624 MANSON PIKE
MURFREESBORO TN
37129-3722
US

V. Phone/Fax

Practice location:
  • Phone: 615-305-6000
  • Fax:
Mailing address:
  • Phone: 615-305-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number029123
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number29123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: