Healthcare Provider Details

I. General information

NPI: 1730457797
Provider Name (Legal Business Name): ERIN J BRADY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN J BEATTY CRNA

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

DEPARTMENT 4676
CAROL STREAM IL
60122-4676
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-6933
  • 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 Number4704263925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: