Provider Demographics
NPI:1477562585
Name:MCCLENAHAN, DANIEL C (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:MCCLENAHAN
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 1:16 ELI LN
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5094
Mailing Address - Country:US
Mailing Address - Phone:208-756-8027
Mailing Address - Fax:
Practice Address - Street 1:16 ELI LN
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5094
Practice Address - Country:US
Practice Address - Phone:208-756-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT32452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT32452OtherSTATE LICENSE NUMBER
IDRNA-623OtherSTATE LICENSE NUMBER