Healthcare Provider Details

I. General information

NPI: 1134452550
Provider Name (Legal Business Name): MARGO ANN KRUGGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

18863 LIVINGSTON DR
MACOMB MI
48042-6223
US

V. Phone/Fax

Practice location:
  • Phone: 248-343-4000
  • Fax:
Mailing address:
  • Phone: 586-382-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704247172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: