Provider Demographics
NPI:1366164824
Name:HORNING, CARISSA SUE (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:SUE
Last Name:HORNING
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:SUE
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9010 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4012
Mailing Address - Country:US
Mailing Address - Phone:734-444-8026
Mailing Address - Fax:
Practice Address - Street 1:5301 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310689163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse