Individual
DEREK PAUL ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Mailing address
2542 TUSON DR, APT 1B, WATERFORD, MI 48329-3366
(248) 408-6964
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704265882
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704265882
DEPARTMENT OF NURSING & REGULATORY AFFAIRS - BOARD OF NURSING
MI
Enumeration date
03/12/2015
Last updated
03/12/2015
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