Healthcare Provider Details

I. General information

NPI: 1043353931
Provider Name (Legal Business Name): KATHLEEN M MCLAREN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

130 TOWN CENTER DR STE 203
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-1684
  • Fax:
Mailing address:
  • Phone: 248-585-8221
  • Fax: 248-585-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704113993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: