Organization
BLACK RIVER ANESTHESIA STAFFING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL WILKINSON (OFFICE MANAGER)
(734) 241-3891
Entity
Organization
Contact information
Practice address
7245 BASELINE RD, SOUTH HAVEN, MI 49090-9176
(734) 241-3891
(734) 241-0014
Mailing address
5623 E DUNBAR RD, MONROE, MI 48161-9127
(734) 241-3891
(734) 241-0014
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
04/22/2020
Last updated
07/09/2020
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