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Individual

DANIEL FORREST SLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
939 CAROLINE ST, PORT ANGELES, WA 98362-3909
(360) 417-7711
Mailing address
660 S COOLIDGE ST, MOSES LAKE, WA 98837-1872
(509) 793-9715
(509) 764-3244

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
201606815CRNA-P
OR
367500000X
Certified Registered Nurse Anesthetist
6134-33
WA
367500000X
Certified Registered Nurse Anesthetist
64001
ID
367500000X
Certified Registered Nurse Anesthetist
712720
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60651342
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2093758
WA
Enumeration date
06/20/2014
Last updated
07/14/2022
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