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General NPI Number Information
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NPI Number | 1013985472
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Entity Type | Individual
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Provider Name | PATRICIA LJUBIC CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 3601 W 13 MILE RD 400 FSC - PCS
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City | ROYAL OAK
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State | MI
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Zip | 48073-6769
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Country | US
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Telephone | 248-423-3144
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Fax |
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Provider Business Mailing Address
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Address Line | 22955 LEE CT
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2721
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Country | US
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Telephone | 586-773-4324
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Fax | 519-979-3020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704124371
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License Number State | MI
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