Individual
LISA LICAVOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1447 N HARRISON ST, SAGINAW, MI 48602-4727
(989) 583-0000
Mailing address
3601 W 31 MILE RD, 400 FSC - PCS, ROYAL OAK, MI 48073-6769
(248) 423-3144
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704189302
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430F364420
BCBSM
MI
05
—
4606097
—
MI
Enumeration date
03/10/2006
Last updated
04/27/2026
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