Provider Demographics
NPI:1760968101
Name:BERMEA, DANIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BERMEA
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 1:0S717 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3414
Mailing Address - Country:US
Mailing Address - Phone:630-362-7636
Mailing Address - Fax:
Practice Address - Street 1:6811 BREMENTOWNE DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1605
Practice Address - Country:US
Practice Address - Phone:630-362-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120001367500000X
TN217261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered