Individual
EVELYN JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5898 AUGUSTA LN, GRAND BLANC, MI 48439-9472
(734) 241-3891
(734) 241-0014
Mailing address
5623 E DUNBAR RD, MONROE, MI 48161-9127
(734) 241-3891
(734) 241-0014
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704138318
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4308751540
BCBS PIN
MI
Enumeration date
01/12/2006
Last updated
07/09/2007
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