Healthcare Provider Details

I. General information

NPI: 1619936929
Provider Name (Legal Business Name): NANCY LEE REYNAERT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD ANESTHESIA
TROY MI
48085-1198
US

IV. Provider business mailing address

750 STEPHENSON HWY BEAUMONT PAYOR CONTRACT SERVICES
TROY MI
48083-1103
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-3000
  • Fax:
Mailing address:
  • Phone: 248-577-3511
  • Fax: 248-577-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704072455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: