Provider Demographics
NPI:1245894351
Name:JEZOWSKI, ALYSSA (CRNA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:JEZOWSKI
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:ACHACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2006 HOGBACK RD.
Mailing Address - Street 2:SUITE 5 A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-712-3456
Mailing Address - Fax:734-712-0133
Practice Address - Street 1:SJMHS-TRINITY HEALTH ANN ARBOR
Practice Address - Street 2:5301 E HURON RIVER DRIVE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-3456
Practice Address - Fax:734-712-0133
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307410367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered