Healthcare Provider Details

I. General information

NPI: 1750349783
Provider Name (Legal Business Name): BLAINE HUGH ARMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 SUNDANCE DR
PEARLAND TX
77584-2892
US

IV. Provider business mailing address

9408 SUNDANCE DR
PEARLAND TX
77584-2892
US

V. Phone/Fax

Practice location:
  • Phone: 281-412-7553
  • Fax:
Mailing address:
  • Phone: 281-412-7553
  • Fax: 936-639-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number570899
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number47380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: