Healthcare Provider Details

I. General information

NPI: 1174014377
Provider Name (Legal Business Name): ALYSSA HABECKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15032 S 8TH ST
SCHOOLCRAFT MI
49087-9484
US

IV. Provider business mailing address

15032 S 8TH ST
SCHOOLCRAFT MI
49087-9484
US

V. Phone/Fax

Practice location:
  • Phone: 269-744-4883
  • Fax:
Mailing address:
  • Phone: 269-744-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704300041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: