Provider Demographics
NPI:1205938891
Name:NASH, DAN R (CRNA)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:R
Last Name:NASH
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 1:1111 N DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2609
Mailing Address - Country:US
Mailing Address - Phone:405-979-8046
Mailing Address - Fax:405-979-8047
Practice Address - Street 1:1111 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2609
Practice Address - Country:US
Practice Address - Phone:405-979-8046
Practice Address - Fax:405-979-8047
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45558367500000X
OK107510367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1301269-03Medicaid
TX88728CMedicare PIN
TX1301269-03Medicaid