Healthcare Provider Details

I. General information

NPI: 1255663936
Provider Name (Legal Business Name): COURTENAY MONEE' HALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

770 N REDWOOD AVE APT. #5
YPSILANTI MI
48198-7534
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-0188
  • Fax:
Mailing address:
  • Phone: 734-489-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704243532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: