Individual
CAROL PATRICIA ST.HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-6593
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704174022
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11905331
CAQH
—
01
—
F36455247
CHMC MEDICARE PTAN
—
Enumeration date
06/19/2006
Last updated
11/13/2012
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