Healthcare Provider Details

I. General information

NPI: 1467472902
Provider Name (Legal Business Name): WENDY RAE CARNEGIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S CRYSTAL COVE
HASLETT MI
48840
US

IV. Provider business mailing address

1715 S CRYSTAL COVE
HASLETT MI
48840
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-1448
  • Fax:
Mailing address:
  • Phone: 517-339-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704088184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: