MEDICARE: CHARLES CHRISTOPHER DANIELS 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	AP60465497	WA
2	367500000X	Certified Registered Nurse Anesthetist	5494384-3102	UT

General Provider Information

NPI Number	:	1699026716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES CHRISTOPHER DANIELS CRNA

Provider Business Mailing Address
First Line	:	505 NE 87TH AVE
Second Line	:	SUITE 46.5
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1989
Country	:	US
Telephone Number	:	360-828-5396
Fax Number	:	360-828-5455

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE
Second Line	:	SUITE 46.5
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1989
Country	:	US
Telephone Number	:	360-828-5396
Fax Number	:	360-828-5455

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	12/04/2025

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