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NPI Code Detail

MEDICARE: DANIEL W. BORVAN CRNA

MEDICARE: DANIEL W. BORVAN 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
1367500000XCertified Registered Nurse Anesthetist209003563IL

General Provider Information

NPI Number : 1962404442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL W. BORVAN CRNA
Provider Business Mailing Address
First Line : 328 E LINCOLN HWY
Second Line :
City : NEW LENOX
State : IL
Zip : 60451-1849
Country : US
Telephone Number : 815-462-8470
Fax Number : 815-462-8471
Provider Business Practice Location Address
First Line : 2233 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-3043
Country : US
Telephone Number : 312-770-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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