Provider Demographics
NPI:1124340989
Name:JABARA, DEVONE (CRNA)
Entity type:Individual
Prefix:
First Name:DEVONE
Middle Name:
Last Name:JABARA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 CADIEUX ROAD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1507
Mailing Address - Country:US
Mailing Address - Phone:313-343-1000
Mailing Address - Fax:
Practice Address - Street 1:130 TOWN CENTER DRIVE STE. 203
Practice Address - Street 2:PAYOR CONTRACT SERVICES
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1103
Practice Address - Country:US
Practice Address - Phone:248-585-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242206367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered