Healthcare Provider Details

I. General information

NPI: 1104842780
Provider Name (Legal Business Name): JERRY J DAWES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ 5TH FLOOR S.O.N.
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-9000
  • Fax: 810-760-0440
Mailing address:
  • Phone: 810-762-7038
  • Fax: 810-760-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704212253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: