Healthcare Provider Details

I. General information

NPI: 1730279191
Provider Name (Legal Business Name): DONALD R FERRARI I CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOHN HEALTH SYSTEM 22101 MOROSS RD.
DETROIT RD. MI
48236
US

IV. Provider business mailing address

35517 HATHERLY PL
STERLING HEIGHTS MI
48310-5139
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4753
  • Fax:
Mailing address:
  • Phone: 586-979-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: