Provider Demographics
NPI:1366628638
Name:FLANDERS, DANIEL TROY (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TROY
Last Name:FLANDERS
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 1:4152 HICKORY HLS
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48428-9243
Mailing Address - Country:US
Mailing Address - Phone:248-431-8898
Mailing Address - Fax:
Practice Address - Street 1:4152 HICKORY HLS
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:MI
Practice Address - Zip Code:48428-9243
Practice Address - Country:US
Practice Address - Phone:248-431-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244553367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered