Provider Demographics
NPI:1225030711
Name:CLANTON, DAVID A (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:CLANTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 E HURON ST STE 5-704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-695-0061
Mailing Address - Fax:312-926-8341
Practice Address - Street 1:251 E HURON ST STE 5-704
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-695-0061
Practice Address - Fax:312-926-8341
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041229591367500000X
IL209000967367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered