Individual
SALLY RANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
36475 5 MILE RD, LIVONIA, MI 48154-1971
(734) 655-2022
Mailing address
47953 PARK LANE CT, CANTON, MI 48187-5469
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704155743
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104199983
—
MI
Enumeration date
06/29/2006
Last updated
09/25/2018
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