Healthcare Provider Details

I. General information

NPI: 1568561264
Provider Name (Legal Business Name): JANET MEREDITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

IV. Provider business mailing address

104 SONG SPARROW TRL
NILES MI
49120-4987
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-5510
  • Fax:
Mailing address:
  • Phone: 269-687-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4704232780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: