=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932103884
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN JOSEPH BLANCHARD CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 04/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 618 HOSPITAL RD
-----------------------------------------------------
City | TAPPAHANNOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22560-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-443-3111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68 S SERVICE RD ST 350
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-2354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-945-3107
-----------------------------------------------------
Fax | 516-945-3131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 0024164241
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------