Provider Demographics
NPI:1578009197
Name:SONNTAG, DANIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SONNTAG
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 1:146 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8528
Mailing Address - Country:US
Mailing Address - Phone:704-662-0877
Mailing Address - Fax:
Practice Address - Street 1:146 MEDICAL PARK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8528
Practice Address - Country:US
Practice Address - Phone:704-662-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116073367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered