Provider Demographics
NPI:1386664720
Name:DOW, MARYANN A (CRNA)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:A
Last Name:DOW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:A
Other - Last Name:DOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:7325 OAKHAVEN CT NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8747
Mailing Address - Country:US
Mailing Address - Phone:407-252-8481
Mailing Address - Fax:
Practice Address - Street 1:3333 EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9493
Practice Address - Country:US
Practice Address - Phone:616-364-4200
Practice Address - Fax:616-364-7347
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9181459367500000X
VA0024178656367500000X
MI4704291005367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3827OtherBCBS
FL3070701 00Medicaid