Individual
KURT LESTER LIBUNAO OMADLAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
47594 VIOLA LN, CHESTERFIELD, MI 48047-2407
(586) 883-0584
Mailing address
47594 VIOLA LN, CHESTERFIELD, MI 48047-2407
(586) 883-0584
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704314907
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704314907
MI
Other
Enumeration date
10/14/2024
Last updated
10/31/2024
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