Healthcare Provider Details

I. General information

NPI: 1073701355
Provider Name (Legal Business Name): OLGA V. HALSTEAD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 11/03/2023
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 W ALBAIN RD
MONROE MI
48161-9555
US

IV. Provider business mailing address

3980 W ALBAIN RD
MONROE MI
48161-9555
US

V. Phone/Fax

Practice location:
  • Phone: 734-457-9814
  • Fax:
Mailing address:
  • Phone: 734-457-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number079494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: