Individual
DANIEL J. RESIDE
Active
Individual
DANIEL J. RESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
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
Update your record
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