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General NPI Number Information
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NPI Number | 1194112482
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Entity Type | Individual
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Provider Name | ALYSSA R ROEGNER CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2689
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Country | US
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Telephone | 313-916-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 54817 LAWSON CREEK DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-3175
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Country | US
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Telephone |
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Fax |
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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 | APRN11038397
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704310398
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN10000050
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License Number State | MA
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