Healthcare Provider Details

I. General information

NPI: 1225650526
Provider Name (Legal Business Name): ANNA REGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANNA NOVAKOSKI

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

16800 ERINS WAY
GRAND LEDGE MI
48837-9767
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704310734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: