Healthcare Provider Details

I. General information

NPI: 1821822941
Provider Name (Legal Business Name): CAMERON BLISSELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

10314 S 2460 E
SANDY UT
84092-4444
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax:
Mailing address:
  • Phone: 878-670-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209030853
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200909
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: