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General NPI Number Information
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NPI Number | 1346511383
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Entity Type | Organization
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Legal Business Name | ST. JOHN PROVIDENCE
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 28000 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-2468
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Country | US
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Telephone | 586-753-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 38221 FERNHILL CT
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City | CLINTON TWP
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State | MI
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Zip | 48038-3422
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Country | US
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Telephone | 586-286-6967
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | MISS ERIN A DOPP
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Credential | MSN, CRNA
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Telephone | 586-286-6967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 89605
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License Number State | MI
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