Healthcare Provider Details

I. General information

NPI: 1780074161
Provider Name (Legal Business Name): DANIEL P PHILLIPS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD AMERICAN ANESTHESIOLOGY OF VIRGINIA, PC
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 973-660-9334
  • Fax:
Mailing address:
  • Phone: 919-882-0705
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024172292
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: