Provider Demographics
NPI:1972971109
Name:ILIAS, VALBONA (CRNA)
Entity type:Individual
Prefix:
First Name:VALBONA
Middle Name:
Last Name:ILIAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VALBONA
Other - Middle Name:ILIAS
Other - Last Name:DORLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:794 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1232
Mailing Address - Country:US
Mailing Address - Phone:313-355-6550
Mailing Address - Fax:
Practice Address - Street 1:794 CADIEUX RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1232
Practice Address - Country:US
Practice Address - Phone:313-355-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281187163W00000X
MI701252367500000X
TXAP129829367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse