Healthcare Provider Details

I. General information

NPI: 1831131978
Provider Name (Legal Business Name): DIANE STOLLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SANDRA CT
DEARBORN HEIGHTS MI
48127-4137
US

IV. Provider business mailing address

707 SANDRA CT
DEARBORN HEIGHTS MI
48127-4137
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-5061
  • Fax: 248-357-0915
Mailing address:
  • Phone: 313-274-5061
  • Fax: 248-357-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704091295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: