MEDICARE: MR. DANE JAMES SLAGLE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	10054799	OR
2	367500000X	Certified Registered Nurse Anesthetist	10054799	OR

General Provider Information

NPI Number	:	1003520750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANE JAMES SLAGLE CRNA

Provider Business Mailing Address
First Line	:	3500 VICTORIA ST # 360A
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-571-4506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	02/09/2026

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