Healthcare Provider Details

I. General information

NPI: 1114099231
Provider Name (Legal Business Name): BLAIR PATRICK WRIGHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FIRST AVENUE
HUNTINGTON WV
25702-1241
US

IV. Provider business mailing address

PO BOX 515
BARBOURSVILLE WV
25504-0515
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-1031
  • Fax:
Mailing address:
  • Phone: 304-736-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number50941
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number08139
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: