Provider Demographics
NPI:1184012833
Name:HOLOWCHAK, ANDREA L (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:HOLOWCHAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:MASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:130 TOWN CENTER DR STE 203
Mailing Address - Street 2:BEAUMONT MEDICAL STAFF AFFAIRS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-964-3000
Mailing Address - Fax:248-964-8448
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:BEAUMONT HOSPITAL - TROY
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-3000
Practice Address - Fax:248-964-8448
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272214367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered