Healthcare Provider Details

I. General information

NPI: 1225840895
Provider Name (Legal Business Name): LOREDANA CHISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

826 W KING ST
OWOSSO MI
48867-2120
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-5211
  • Fax: 989-723-5274
Mailing address:
  • Phone: 989-723-5211
  • Fax: 989-723-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704296093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: