Healthcare Provider Details

I. General information

NPI: 1750482717
Provider Name (Legal Business Name): ELIZABETH A BLAZEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY BLAZEY CRNA

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DRIVE
NORTH KANSAS CITY MO
64116
US

IV. Provider business mailing address

PO BOX 7391
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-2000
  • Fax:
Mailing address:
  • Phone: 816-221-5050
  • Fax: 816-471-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN092210
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: