Active NPI
Kimberly A Manzaroli, CRNA
- Certified Registered Nurse Anesthetist
- Warren, MI
National Provider Identifier
1013074491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704127509
- Practice address
- 11800 E 12 Mile Rd
Warren, MI 48093-3472 - Phone
- (586) 573-5260
- Fax
- (586) 573-5364
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4704127509 | MI | Primary |
Addresses
Primary practice location
11800 E 12 Mile Rd
Warren, MI 48093-3472
Mailing address
11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5260
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1905127 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704127509 | MI | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013074491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11800 E 12 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480933472",
"telephone_number": "586-573-5260",
"fax_number": "586-573-5364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11800 E 12 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480933472",
"telephone_number": "586-573-5260",
"fax_number": "586-573-5364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZAROLI",
"first_name": "KIMBERLY",
"middle_name": "A",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704127509",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1905127",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.