Healthcare Provider Details

I. General information

NPI: 1801957212
Provider Name (Legal Business Name): ADELE THERESA ALEF CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2371
  • Fax: 586-263-2596
Mailing address:
  • Phone: 586-263-2371
  • Fax: 586-263-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704174625
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11013121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: