Healthcare Provider Details

I. General information

NPI: 1295284214
Provider Name (Legal Business Name): JING ZHANG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

6655 JACKSON RD UNIT 455
ANN ARBOR MI
48103-9578
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4210
  • Fax:
Mailing address:
  • Phone: 989-495-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704279738
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: