Healthcare Provider Details

I. General information

NPI: 1295700318
Provider Name (Legal Business Name): CHRISTOPHER QUERTERMUS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 ANGLING RD
PORTAGE MI
49024-0714
US

IV. Provider business mailing address

10466 N 17TH ST
PLAINWELL MI
49080-8606
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-8406
  • Fax:
Mailing address:
  • Phone: 269-269-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704216255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: