Healthcare Provider Details

I. General information

NPI: 1831605344
Provider Name (Legal Business Name): KRISTINE ROSE VEACH CRNA, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE ROSE HILTON

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

22523 CRANBROOKE DR
NOVI MI
48375-4503
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3456
  • Fax:
Mailing address:
  • Phone: 586-484-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704292916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: