MEDICARE: DAVID A. CLANTON 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	367500000X	Certified Registered Nurse Anesthetist	041229591	IL
2	367500000X	Certified Registered Nurse Anesthetist	209000967	IL

General Provider Information

NPI Number	:	1225030711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A. CLANTON CRNA

Provider Business Mailing Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-695-0061
Fax Number	:	312-926-8341

Provider Business Practice Location Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-695-0061
Fax Number	:	312-926-8341

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/09/2020

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Directions to “ DAVID A. CLANTON CRNA” Practice Location

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