Provider Demographics
NPI:1033121710
Name:POUGET, ILONA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:
Last Name:POUGET
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 1:2226 GLADSTONE AVE.
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONT.
Mailing Address - Zip Code:N8W 2N7
Mailing Address - Country:CA
Mailing Address - Phone:519-254-4127
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-3370
Practice Address - Fax:313-343-6862
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704093731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered