Healthcare Provider Details

I. General information

NPI: 1891029195
Provider Name (Legal Business Name): NICOLE ELIZABETH KARRIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ELIZABETH KARRIS CRNA, MS

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
W BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

405 N VERMONT AVE
ROYAL OAK MI
48067-2098
US

V. Phone/Fax

Practice location:
  • Phone: 248-825-1912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704247287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: