Provider Demographics
NPI:1386680650
Name:CHRISTEN, DAN LYLE (CRNA)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:LYLE
Last Name:CHRISTEN
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 1:5953 N PARCHMENT PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1225
Mailing Address - Country:US
Mailing Address - Phone:208-938-1584
Mailing Address - Fax:254-778-7197
Practice Address - Street 1:111 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6127
Practice Address - Country:US
Practice Address - Phone:208-336-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-516A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered