Individual
CARMEN G KISLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
33155 ANNAPOLIS ST, WAYNE, MI 48184-2405
(734) 467-4667
(734) 467-2303
Mailing address
33155 ANNAPOLIS ST, WAYNE, MI 48184-2405
(734) 467-4667
(734) 467-2303
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704210733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4328730
—
MI
Enumeration date
11/01/2006
Last updated
07/08/2007
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