Individual
LAUREN ALEXIS KALLIANTASIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Mailing address
55537 TIMBERS EDGE DR, SHELBY TOWNSHIP, MI 48316-5363
(248) 688-7908
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
4704309721
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704309721NSA190D3
MI
Other
Enumeration date
06/16/2019
Last updated
10/14/2019
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