Provider Demographics
NPI:1710955042
Name:MILETO, LISA ANN (CRNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MILETO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 PINEVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8890
Mailing Address - Country:US
Mailing Address - Phone:810-986-9711
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6120
Practice Address - Country:US
Practice Address - Phone:517-332-1200
Practice Address - Fax:517-351-7122
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5469367500000X
MI4704160785367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430F364420OtherBCBSM
MI41152OtherNBCRNA
MI2749045Medicaid
MI430F364420OtherBCBSM