Provider Demographics
NPI:1225048259
Name:BOOTEN, DANIEL LINN (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LINN
Last Name:BOOTEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 MANSON PIKE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3722
Mailing Address - Country:US
Mailing Address - Phone:615-305-6000
Mailing Address - Fax:
Practice Address - Street 1:4624 MANSON PIKE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3722
Practice Address - Country:US
Practice Address - Phone:615-305-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH029123367500000X
SC29123367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered