Provider Demographics
NPI:1518924331
Name:DIEGEL, URSZULA ANETA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:URSZULA
Middle Name:ANETA
Last Name:DIEGEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:URSULA
Other - Middle Name:ANETA
Other - Last Name:SMOTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT 203401
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:952-442-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165170367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104300865Medicaid
MIUS165170OtherBLUE CROSS OF MI
MIN24360189Medicare ID - Type Unspecified
MI430065309Medicare ID - Type UnspecifiedRAILROAD MEDICARE