Individual
WANDA E ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
18100 OAKWOOD BLVD, SUITE 100, DEARBORN, MI 48124-4085
(313) 253-2000
Mailing address
18100 OAKWOOD BLVD, SUITE 100, DEARBORN, MI 48124-4085
(313) 253-2000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704170931
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4311250
—
MI
05
—
4415531
—
MI
Enumeration date
07/18/2006
Last updated
07/08/2007
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