Individual
MR. JEFFREY DEAN BOUNSALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
27545 FRANKLIN RD APT 107, SOUTHFIELD, MI 48034-8249
(248) 350-2718
Mailing address
27545 FRANKLIN RD APT 107, SOUTHFIELD, MI 48034-8249
(248) 350-2718
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
077154
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077154
AANA LICENSE
MI
01
—
4704242898
RN LICENSE NUMBER
MI
Enumeration date
01/21/2007
Last updated
07/08/2007
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