Healthcare Provider Details

I. General information

NPI: 1881809846
Provider Name (Legal Business Name): JOSHUA LOGAN BARRON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2960 SANDLEWOOD COURT
LASALLE ONTARIO
N9H 2S3
CA

V. Phone/Fax

Practice location:
  • Phone: 313-916-2600
  • Fax:
Mailing address:
  • Phone: 519-969-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704241569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: