Provider Demographics
NPI:1750498663
Name:COVERSON, JO-ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:JO-ANN
Middle Name:
Last Name:COVERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JO-ANN
Other - Middle Name:
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:23208 MISSION LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3113
Mailing Address - Country:US
Mailing Address - Phone:248-821-9989
Mailing Address - Fax:248-427-0292
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-593-7820
Practice Address - Fax:313-593-8894
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117825367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4311608Medicaid
MI4843467Medicaid
MI430060331Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI4843467Medicaid
MI0N21370028Medicare ID - Type Unspecified