Individual
TARA CRISANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN, SRNA
Contact information
Practice address
259 MACK AVE, DETROIT, MI 48201-2427
(248) 880-8477
Mailing address
259 MACK AVE, DETROIT, MI 48201-2427
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704322680
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704322680
MI
Other
Enumeration date
05/18/2023
Last updated
08/23/2023
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