Provider Demographics
NPI:1053632687
Name:DOROBEK, KRYSTLE MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:MARIE
Last Name:DOROBEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:MARIE
Other - Last Name:HITESHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 67000 DEPT 212501
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:734-671-6800
Mailing Address - Fax:734-671-3891
Practice Address - Street 1:5450 FORT STREET
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-671-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered