Provider Demographics
NPI:1952525966
Name:METTLER, DAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:METTLER
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 1:11220 338TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-6801
Mailing Address - Country:US
Mailing Address - Phone:605-577-6240
Mailing Address - Fax:
Practice Address - Street 1:11220 338TH AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-6801
Practice Address - Country:US
Practice Address - Phone:605-577-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26023367500000X
SDR020291367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3802OtherCRNA