Provider Demographics
NPI:1912013574
Name:TURNER, PHYLLIS S (CRNA)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:S
Last Name:TURNER
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 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:ANESTHESIA DEPT.
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4089
Mailing Address - Country:US
Mailing Address - Phone:313-593-7820
Mailing Address - Fax:313-539-8894
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7820
Practice Address - Fax:313-539-8894
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704070629367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4311840Medicaid
MI430060378Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0N21370064Medicare ID - Type Unspecified