Individual
JEFFERY JAMES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
23901 LAHSER RD, SOUTHFIELD, MI 48033-6035
(248) 357-3360
Mailing address
2173 DECKER RD APT 48, WALLED LAKE, MI 48390-2509
(248) 701-7782
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704215208
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104692611
—
MI
01
—
JJ215208
BLUE CROSS OF MI
MI
Enumeration date
05/23/2006
Last updated
01/10/2024
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