Individual
MARY M MCMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(586) 610-5523
Mailing address
8762 MARQUETTE DR, GROSSE ILE, MI 48138-1566
(734) 755-8123
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704138586
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3427707
—
MI
Enumeration date
08/15/2006
Last updated
03/10/2021
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