Individual
MR. WILLIAM WAYNE LANDESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
16913 ERINS WAY, GRAND LEDGE, MI 48837-9767
(517) 627-7675
(517) 622-3537
Mailing address
16913 ERINS WAY, GRAND LEDGE, MI 48837-9767
(517) 627-7675
(517) 622-3537
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704156475
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20000130
PHYSICIAN'S HEALTH PLAN
MI
01
—
2070130
PHP FAMILY CARE
MI
01
—
WL156475
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/29/2006
Last updated
07/08/2007
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