Provider Demographics
NPI:1407895782
Name:DAY, CLARENCE ROBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:ROBERT
Last Name:DAY
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 1:3020 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2331
Mailing Address - Country:US
Mailing Address - Phone:612-724-4973
Mailing Address - Fax:651-509-8050
Practice Address - Street 1:245 RUTH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4323
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-509-8050
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0738000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered