Provider Demographics
NPI:1760712327
Name:DANIEL, BEAU S (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:S
Last Name:DANIEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3750
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3750
Mailing Address - Country:US
Mailing Address - Phone:800-880-3566
Mailing Address - Fax:770-701-6676
Practice Address - Street 1:285 VISTA DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4987
Practice Address - Country:US
Practice Address - Phone:208-478-1704
Practice Address - Fax:770-701-6673
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-936A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered