Individual
RAYMOND JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(952) 442-9770
Mailing address
PO BOX 67000, DETROIT, MI 48267-0001
(952) 442-9770
(952) 442-3630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704164114
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104357320
—
MI
01
—
RJ164114
BLUE CROSS OF MI
MI
Enumeration date
07/05/2006
Last updated
06/22/2011
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