Healthcare Provider Details

I. General information

NPI: 1528431780
Provider Name (Legal Business Name): DANIELLE OLEJNICZAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32000 TELEGRAPH RD
BINGHAM FARMS MI
48025-2442
US

IV. Provider business mailing address

21378 JOHN DR
MACOMB MI
48044-6405
US

V. Phone/Fax

Practice location:
  • Phone: 248-647-5800
  • Fax:
Mailing address:
  • Phone: 586-764-3878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704266291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: