Individual
JILLIAN MOURANIE CHAMPINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2006 HOGBACK RD STE 5A, ANN ARBOR, MI 48105-9750
(734) 263-2417
Mailing address
130 TOWN CENTER DR STE 203, BEAUMONT PHYSICIAN PARTNERS PAYOR ENROLLMENT, TROY, MI 48084-1744
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704266732
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430F364420
BCBSM
MI
Enumeration date
02/14/2013
Last updated
01/14/2025
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