Provider Demographics
NPI:1538965561
Name:METIVA, BROOKE DENAE (CRNA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:DENAE
Last Name:METIVA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DENAE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7927 CELOSIA DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7743
Mailing Address - Country:US
Mailing Address - Phone:989-313-9273
Mailing Address - Fax:
Practice Address - Street 1:1355 BOGUE ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6207
Practice Address - Country:US
Practice Address - Phone:800-605-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered