Provider Demographics
NPI:1427025477
Name:WALDRON, MICHELE HUBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:HUBERT
Last Name:WALDRON
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 1:47700 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2458
Mailing Address - Country:US
Mailing Address - Phone:586-419-4493
Mailing Address - Fax:
Practice Address - Street 1:47700 ROBIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-2458
Practice Address - Country:US
Practice Address - Phone:586-419-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136171367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4593678Medicaid
MI430F364420OtherBCBSM
MI0F36442277Medicare ID - Type Unspecified
MI4593678Medicaid