Individual
JASON BARRY BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-2037
Mailing address
21921 TROMBLY ST, SAINT CLAIR SHORES, MI 48080-1282
(586) 899-0774
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704286557
MI
Other
Enumeration date
01/29/2018
Last updated
01/29/2018
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