Healthcare Provider Details

I. General information

NPI: 1649232091
Provider Name (Legal Business Name): BRENDA L VECCHIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

875 HUNTINGTON DR
SOUTH LYON MI
48178-2529
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704140862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: