Provider Demographics
NPI:1861485021
Name:SIMONSON, DANIEL CHARLES (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CHARLES
Last Name:SIMONSON
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:
Practice Address - Street 1:16818 E DESMET CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3542
Practice Address - Country:US
Practice Address - Phone:509-456-5380
Practice Address - Fax:509-456-5381
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00083645163W00000X
IDRNA-919A367500000X
WAAP30004926367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35225OtherLABOR AND INDUSTRIES
WA1020826Medicaid
ID1861485021Medicaid
WA430030686OtherRAILROAD MEDICARE
WAG8949118OtherMEDICARE WA
WAR11661Medicare UPIN
WA000381508Medicare ID - Type Unspecified