Individual
DAN CLARENCE TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
809 UNIVERSITY BLVD E, TUSCALOOSA, AL 35401-2029
(205) 759-7352
(205) 759-6397
Mailing address
809 UNIVERSITY BLVD E, TUSCALOOSA, AL 35401-2029
(205) 759-7352
(205) 759-6397
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-046372
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
1-046372
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040543
AMERICAN ASSOCIATION OF NURSE ANESTHETISTS (CERTIFICATION)
AL
Enumeration date
06/28/2006
Last updated
11/03/2010
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