Individual
DANIEL ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
250 PARK ST, BOWLING GREEN, KY 42101-1760
(270) 393-1912
(270) 393-1913
Mailing address
825 2ND AVE, SUITE C6, BOWLING GREEN, KY 42101-1786
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3008449
KY
390200000X
Student in an Organized Health Care Education/Training Program
155950
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100275390
—
KY
Enumeration date
11/02/2013
Last updated
01/27/2017
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