Provider Demographics
NPI:1982780599
Name:CALABRESE, KATHY MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:CALABRESE
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 1:28932 OLDBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1713
Mailing Address - Country:US
Mailing Address - Phone:586-598-8267
Mailing Address - Fax:
Practice Address - Street 1:26755 BALLARD ST
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-2419
Practice Address - Country:US
Practice Address - Phone:586-466-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704128526367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered