Healthcare Provider Details

I. General information

NPI: 1467951871
Provider Name (Legal Business Name): NIA PATEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOSEPH MERCY OAKLAND HOSPITAL 44405 WOODWARD AVE
PONTIAC MI
48341
US

IV. Provider business mailing address

2006 HOGBACK RD, SUITE 5A
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 248-585-3023
  • Fax: 248-585-3022
Mailing address:
  • Phone: 734-263-2395
  • Fax: 734-773-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN648457
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704380364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: