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Individual

BEVERLY-JEAN BRISKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
3990 JOHN R ST, DETROIT, MI 48267-0001
(952) 442-9770
(952) 442-3630
Mailing address
PO BOX 67000, DEPT 203401, DETROIT, MI 48267-0002
(952) 442-9770

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704120347
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104486284
MI
01
BB120347
BLUE CROSS OF MI
MI
Enumeration date
08/14/2006
Last updated
03/31/2011
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