Provider Demographics
NPI:1326037052
Name:GREENWALD, DANIEL MARK (CRNA, ARNP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:CRNA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:360-336-6517
Mailing Address - Fax:360-757-3870
Practice Address - Street 1:111 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4105
Practice Address - Country:US
Practice Address - Phone:360-336-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000594367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0124116OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA2533GROtherREGENCE BLUE SHIELD
WA500008683OtherRAILROAD MEDICARE
WA9622317Medicaid
WAGAB04866Medicare PIN