Provider Demographics
NPI:1790752202
Name:COURVAL WENY, MICHELE LYNN-KLAMMER (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN-KLAMMER
Last Name:COURVAL WENY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNN-KLAMMER
Other - Last Name:COURVAL WENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1086 GENTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-770-9018
Mailing Address - Fax:
Practice Address - Street 1:25500 MEADOWBROOK
Practice Address - Street 2:
Practice Address - City:NOVI MI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-229-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217352163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4676073Medicaid
MIM17794057Medicaid
MI430F364420OtherBCBSM
MIQ33001Medicare UPIN