Provider Demographics
NPI:1649389917
Name:REAMES, DARYL V (CRNA)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:V
Last Name:REAMES
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 1:12606 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-3421
Mailing Address - Country:US
Mailing Address - Phone:509-473-5484
Mailing Address - Fax:
Practice Address - Street 1:12606 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3421
Practice Address - Country:US
Practice Address - Phone:509-473-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005931367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806203100Medicaid
WA9631367Medicaid
WA244056OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA244071OtherDEPARTMENT OF LABOR AND INDUSTRIES
WAG8878455Medicare PIN
WAG8878453Medicare PIN
WA244056OtherDEPARTMENT OF LABOR AND INDUSTRIES