Individual
MARISA LEIGH DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2172
(313) 343-4000
Mailing address
3968 CLOVERLANE DR, YPSILANTI, MI 48197-5059
(734) 752-5629
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704296535
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704296535
MI
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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