Individual
CIVITA L DANGELA-WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
248 ARGYLE ST, BIRMINGHAM, MI 48009-1529
(248) 723-1738
Mailing address
248 ARGYLE ST, BIRMINGHAM, MI 48009-1529
(248) 723-1738
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704205386
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104594441
—
MI
05
—
1487719357
—
MI
01
—
CD205386
BLUE CROSS OF MI
MI
Enumeration date
04/13/2006
Last updated
02/12/2025
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