Healthcare Provider Details

I. General information

NPI: 1831557263
Provider Name (Legal Business Name): JILLIAN BROOKE MORSE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W WESTERN AVE SUITE B
MUSKEGON MI
49440-1045
US

IV. Provider business mailing address

2764 FOUNTAIN VIEW CIR APARTMENT 107
NAPLES FL
34109-2725
US

V. Phone/Fax

Practice location:
  • Phone: 231-726-4498
  • Fax:
Mailing address:
  • Phone: 810-241-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704249072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: