Provider Demographics
NPI:1477115566
Name:MASTAY, RACHEL LAUREN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LAUREN
Last Name:MASTAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:THULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:950 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE PT WDS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1442
Mailing Address - Country:US
Mailing Address - Phone:586-530-4278
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299944163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse