Provider Demographics
NPI:1457397333
Name:LANDESS, TWYLA ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TWYLA
Middle Name:ANN
Last Name:LANDESS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:TWYLA
Other - Middle Name:ANN
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 E HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1629
Mailing Address - Country:US
Mailing Address - Phone:517-543-1050
Mailing Address - Fax:517-543-0875
Practice Address - Street 1:321 E HARRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1629
Practice Address - Country:US
Practice Address - Phone:517-543-1050
Practice Address - Fax:517-543-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156537367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4308754070OtherBLUE CROSS BLUE SHIELD
MI102971323Medicaid
MI102971323Medicaid