Individual
MARY-AGNES KNOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2799 W GRAND BLVD FL 3, DETROIT, MI 48202-2608
(800) 653-6568
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704159911
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104624738
—
MI
01
—
MK159911
BLUE CROSS OF MI
MI
Enumeration date
07/29/2006
Last updated
03/29/2023
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