Healthcare Provider Details

I. General information

NPI: 1639138977
Provider Name (Legal Business Name): CYNTHIA HOLLAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W. 13 MILE RD
ROYAL OAK MI
48073-6769
US

IV. Provider business mailing address

3601 W. 13 MILE RD
ROYAL OAK MI
48073-6769
US

V. Phone/Fax

Practice location:
  • Phone: 248-423-2481
  • Fax:
Mailing address:
  • Phone: 248-423-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704120492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: