Basic Information
| Provider Information | |||||||||
| NPI: | 1275019523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANCHEV | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ALEXEEV | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2113 BROOKHURST ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271062409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054126345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1122 NE 13TH ST # 274 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2018 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 290322 | NC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.