Healthcare Provider Details

I. General information

NPI: 1598215451
Provider Name (Legal Business Name): REBECCA TULIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49187 PENINSULAR DR
BELLEVILLE MI
48111-4977
US

IV. Provider business mailing address

49187 PENINSULAR DR
BELLEVILLE MI
48111-4977
US

V. Phone/Fax

Practice location:
  • Phone: 734-775-2201
  • Fax:
Mailing address:
  • Phone: 734-775-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704250795
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: