Provider Demographics
NPI:1316501877
Name:SOVA, LINDSAY TAYLOR (CRNA)
Entity type:Individual
Prefix:MISS
First Name:LINDSAY
Middle Name:TAYLOR
Last Name:SOVA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:TAYLOR
Other - Last Name:GBUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48370 BINGHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8682
Mailing Address - Country:US
Mailing Address - Phone:248-982-0523
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered