Individual
MS. JESSERIE JANELLE LAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4800
Mailing address
24620 PRINCETON ST, DEARBORN, MI 48124-3114
(313) 407-8335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704299396
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136556
NBCRNA
—
01
—
4704299396
BOARD OF NURSING
MI
01
—
851385
BOARD OF NURSING
CA
Enumeration date
07/16/2021
Last updated
07/16/2021
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