Provider Demographics
NPI:1265419915
Name:WANG, EVELINA M (CRNA)
Entity type:Individual
Prefix:
First Name:EVELINA
Middle Name:M
Last Name:WANG
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:1H247 UNIVERSITY HOSPITAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:313-343-3370
Practice Address - Fax:313-343-6862
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2015-06-26
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Provider Licenses
StateLicense IDTaxonomies
MI4704208529367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104754465Medicaid
MIEW208529OtherBLUE CROSS OF MI