Individual
JOHN PEMBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
23491 NORWOOD ST, OAK PARK, MI 48237-2203
(248) 495-9694
Mailing address
23491 NORWOOD ST, OAK PARK, MI 48237-2203
(248) 495-9694
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704327563
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704327563
MI
Other
Enumeration date
05/16/2023
Last updated
08/24/2023
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