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General NPI Number Information
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NPI Number | 1679869168
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Entity Type | Individual
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Provider Name | BLAINE EMANUEL RIDER CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 808 RUSSELL PALMER RD
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City | KINGWOOD
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State | TX
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Zip | 77339-1689
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Country | US
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Telephone | 281-540-0685
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Fax | 281-540-0684
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Provider Business Mailing Address
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Address Line | 1610 LEAFHOPPER LN
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City | CONROE
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State | TX
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Zip | 77301-5306
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Country | US
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Telephone | 337-322-4753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP120948
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 087222
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License Number State | MO
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