Healthcare Provider Details

I. General information

NPI: 1417404591
Provider Name (Legal Business Name): DIPTI N NARULA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

2573 COBDEN DR
STERLING HEIGHTS MI
48310-6944
US

V. Phone/Fax

Practice location:
  • Phone: 313-310-0943
  • Fax:
Mailing address:
  • Phone: 248-765-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704293229
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: