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NPI Code Detail

MEDICARE: MRS. JENNY ANN BEAUREGARD CRNA

MEDICARE: MRS. JENNY ANN BEAUREGARD CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704107072MI

General Provider Information

NPI Number : 1720064934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNY ANN BEAUREGARD CRNA
Provider Business Mailing Address
First Line : 14820 ARTESIAN ST
Second Line :
City : DETROIT
State : MI
Zip : 48223-2229
Country : US
Telephone Number : 313-837-9651
Fax Number :
Provider Business Practice Location Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 313-837-9651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 07/08/2007

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