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General NPI Number Information
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NPI Number | 1942411848
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Entity Type | Individual
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Provider Name | JASON ANTHONY BLANKENSHIP CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 2205 NE 129TH ST
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City | VANCOUVER
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State | WA
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Zip | 98686-3252
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Country | US
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Telephone | 360-694-2544
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Fax | 360-694-1356
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | CHEHALIS
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State | WA
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Zip | 98532-2409
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Country | US
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Telephone | 360-748-8632
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Fax | 360-748-3869
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 200440093RN
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License Number State | OR
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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 | 201160007CRNA
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 63699
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP60800275
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License Number State | WA
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