Provider Demographics
NPI:1376579466
Name:MCNISH, WILLIAM GEORGE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:MCNISH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 W. MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:UBLY
Mailing Address - State:MI
Mailing Address - Zip Code:48475-9784
Mailing Address - Country:US
Mailing Address - Phone:989-658-9026
Mailing Address - Fax:
Practice Address - Street 1:3559 PINE STREET
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427
Practice Address - Country:US
Practice Address - Phone:810-376-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704088940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered