Provider Demographics
NPI:1174553051
Name:MOOS, DANIEL D (CRNA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:MOOS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1771
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1771
Mailing Address - Country:US
Mailing Address - Phone:308-236-5506
Mailing Address - Fax:308-236-7089
Practice Address - Street 1:10 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2908
Practice Address - Country:US
Practice Address - Phone:308-236-5506
Practice Address - Fax:308-236-7089
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100581367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068752615Medicaid
NE47068752615Medicaid