Provider Demographics
NPI:1487697363
Name:CHRISTIAN, WILLECIA A (CRNA)
Entity type:Individual
Prefix:
First Name:WILLECIA
Middle Name:A
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38770 GARFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6620
Mailing Address - Country:US
Mailing Address - Phone:586-412-8355
Mailing Address - Fax:586-412-8608
Practice Address - Street 1:38770 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6620
Practice Address - Country:US
Practice Address - Phone:586-412-8355
Practice Address - Fax:586-412-8608
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215104363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4840779-10Medicaid
MI5008605950OtherBCBS
MI5008605950OtherBCBS