Healthcare Provider Details

I. General information

NPI: 1538383492
Provider Name (Legal Business Name): DANIELLE RENEE BLANKENSHIP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 RIDGELY AVE STE 101
ANNAPOLIS MD
21401-1087
US

IV. Provider business mailing address

473 CARDIFF CT
SEVERNA PARK MD
21146-1617
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-4887
  • Fax: 410-224-1428
Mailing address:
  • Phone: 443-257-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR153376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: