Provider Demographics
NPI:1962515957
Name:SILVERI, NANCY L (CRNA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:SILVERI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:L
Other - Last Name:DESGRANDCHAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:468 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1507
Mailing Address - Country:US
Mailing Address - Phone:313-343-1684
Mailing Address - Fax:
Practice Address - Street 1:468 CADIEUX RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1507
Practice Address - Country:US
Practice Address - Phone:313-343-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704088371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2836033Medicaid