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NPI Code Detail

MEDICARE: LEANNE GRACE VANGILDER CRNA

MEDICARE: LEANNE GRACE VANGILDER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704326425MI

General Provider Information

NPI Number : 1174194203
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNE GRACE VANGILDER CRNA
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-874-6256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 01/27/2026

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Directions to “ LEANNE GRACE VANGILDER CRNA” Practice Location

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