Healthcare Provider Details

I. General information

NPI: 1427152453
Provider Name (Legal Business Name): THRESIA LYNN BLANKENSHIP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 S 5TH ST
GADSDEN AL
35901-5102
US

IV. Provider business mailing address

2231 VERANDA TRCE
HOKES BLUFF AL
35903-7382
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-1253
  • Fax:
Mailing address:
  • Phone: 256-494-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-051907
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: