MEDICARE: KAITLYN ROKITA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	2017024751	MO
2	163WC0200X	Critical Care Medicine Registered Nurse	18346151218	MI
3	367500000X	Certified Registered Nurse Anesthetist	47465	OH

General Provider Information

NPI Number	:	1407318140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ROKITA CRNA

Provider Business Mailing Address
First Line	:	3412 GOLFSIDE RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-3727
Country	:	US
Telephone Number	:	636-578-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2691
Country	:	US
Telephone Number	:	419-251-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	01/11/2023

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