Individual
DANIEL J. RESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Mailing address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041210365
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031308
HEALTH ALLIANCE
IL
01
—
041210365
IL LICENSE #
IL
01
—
0841504038
BCBS OF ILLINOIS
IL
01
—
209-005621
IL APN LICENSE #
IL
01
—
41956
AANA#
IL
01
—
L031806
TRICARE
IL
Enumeration date
10/13/2005
Last updated
07/09/2007
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