Healthcare Provider Details

I. General information

NPI: 1801873419
Provider Name (Legal Business Name): DENISE ANN CARRIER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

DEPT 203401 PO BOX 67000
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-9770
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number47711
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704161784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: