Healthcare Provider Details

I. General information

NPI: 1194994608
Provider Name (Legal Business Name): TERRI LYNN PEACE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEALTH PARK BLVD
GRAND BLANC MI
48439-2558
US

IV. Provider business mailing address

600 HEALTH PARK BLVD
GRAND BLANC MI
48439-2558
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-8210
  • Fax:
Mailing address:
  • Phone: 810-603-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704176595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: