{"npi":"1740244177","type":"NPI-1","status":"active","name":{"display":"Civita Dangela-Wicks CRNA","other":[],"first":"CIVITA","last":"DANGELA-WICKS","middle":"L","credential":"CRNA"},"specialty":{"primary_taxonomy":"367500000X","primary_taxonomy_description":"Certified Registered Nurse Anesthetist","slug":"certified-registered-nurse-anesthetist","schema_org_specialty":null,"all":[{"code":"367500000X","description":"Certified Registered Nurse Anesthetist","primary":true,"state":"MI","license":"4704205386"}]},"addresses":[{"purpose":"LOCATION","street_1":"248 ARGYLE ST","city":"BIRMINGHAM","state":"MI","postal_code":"480091529","country_code":"US","phone":"2487231738"},{"purpose":"MAILING","street_1":"248 ARGYLE ST","city":"BIRMINGHAM","state":"MI","postal_code":"480091529","country_code":"US","phone":"2487231738"}],"license":{"state":"MI","number":"4704205386"},"identifiers":[{"type_code":"01","label":"Other","value":"CD205386","state":"MI","issuer":"BLUE CROSS OF MI"},{"type_code":"05","label":"Medicaid","value":"1487719357","state":"MI","issuer":null},{"type_code":"05","label":"Medicaid","value":"104594441","state":"MI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20040617000333","type_code":"14-43","type_desc":"PRACTITIONER - CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)","state":"MI","pac_id":"4486638368"}]},"enumeration_date":"2006-04-13","last_updated":"2025-02-12","_meta":{"source":"NPPES","snapshot_date":"2025-02-12","doc_url":"https://findmynpi.com/api"}}