Healthcare Provider Details

I. General information

NPI: 1366081044
Provider Name (Legal Business Name): KATIE N KOZELI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE N MCLANE

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

745 W RIDGE CT
LAKE ORION MI
48359-1746
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2978
  • Fax:
Mailing address:
  • Phone: 586-944-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number129609
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704314185
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: