Healthcare Provider Details

I. General information

NPI: 1669830162
Provider Name (Legal Business Name): MICHELLE INGALLS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE HULL

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE ANESTHESIA DEPARTMENT - CRNA
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE ANESTHESIA DEPARTMENT - CRNA
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-4963
  • Fax: 517-780-7352
Mailing address:
  • Phone: 517-780-4963
  • Fax: 517-780-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP141750
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704267590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: