Provider Demographics
NPI:1154367399
Name:HOLMES-ROSS, MARGARETE (CRNA)
Entity type:Individual
Prefix:
First Name:MARGARETE
Middle Name:
Last Name:HOLMES-ROSS
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 1:244 ARDEN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1302
Mailing Address - Country:US
Mailing Address - Phone:313-873-3724
Mailing Address - Fax:248-357-0915
Practice Address - Street 1:244 ARDEN PARK BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1302
Practice Address - Country:US
Practice Address - Phone:313-873-3724
Practice Address - Fax:248-357-0915
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704070136367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMH070136OtherBCBSM NUMBER
MIMH070136OtherBCBSM NUMBER