Healthcare Provider Details

I. General information

NPI: 1346206802
Provider Name (Legal Business Name): MELANIE KROHN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30200 TELEGRAPH RD SUITE 220
BINGHAM FARMS MI
48025-4502
US

IV. Provider business mailing address

4917 TRESSA DR
LANSING MI
48910-5142
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-5058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704127719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: