Individual
MICHAEL RAYMOND IMBLEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 989-3754
(810) 985-2633
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 989-3754
(810) 985-2633
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704234499
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704234499
REGISTERED NURSE LICENSE
MI
Enumeration date
11/22/2006
Last updated
07/08/2007
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