Provider Demographics
NPI:1417195819
Name:BURROUGHS, RUAIDA S (CRNA)
Entity Type:Individual
Prefix:
First Name:RUAIDA
Middle Name:S
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RUAIDA
Other - Middle Name:
Other - Last Name:ENERIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19498 ANTAGO ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2514
Mailing Address - Country:US
Mailing Address - Phone:248-722-0769
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered