Provider Demographics
NPI:1073682134
Name:DAVID, JASMIN J (CRNA)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:J
Last Name:DAVID
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:J
Other - Last Name:BARBOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:586-493-8747
Mailing Address - Fax:
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6500
Practice Address - Fax:906-337-6582
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204023367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704204023OtherSTATE LICENSE