Individual
NICOLETTE KRISTIN ELIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(800) 874-4806
Mailing address
3430 E 4TH ST UNIT 3045, ONTARIO, CA 91764-5066
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
818374
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
4704378265
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119406
NBCRNA
CA
01
—
818374
BRN
CA
Enumeration date
10/15/2017
Last updated
09/15/2022
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