Healthcare Provider Details

I. General information

NPI: 1245207968
Provider Name (Legal Business Name): LINDA MARIE SLAVIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S BALLENGER HWY ATTN SURGICAL SERVICES
FLINT MI
48532-3638
US

IV. Provider business mailing address

401 S BALLENGER HWY ATTN SURGICAL SERVICES
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-4917
  • Fax: 810-342-1335
Mailing address:
  • Phone: 810-342-4917
  • Fax: 810-342-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704150687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: