| NPI | 1912301094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director Of Provider Affairs 313-874-4806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2025-05-20 |