Healthcare Provider Details

I. General information

NPI: 1134517246
Provider Name (Legal Business Name): MEGAN MAE PINOZZI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MAE PHILLIPS

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 10/06/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

4676 DEPARTMENT
CAROL STREAM IL
60122-4676
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-7600
  • Fax: 952-442-3620
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704267372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: