MEDICARE: DONNA K BLAIR CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APN295	SC
2	367500000X	Certified Registered Nurse Anesthetist	2559	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760445795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA K BLAIR CRNA

Provider Business Mailing Address
First Line	:	2543 BACHMAN CHAPEL RD
Second Line	:
City	:	PROSPERITY
State	:	SC
Zip	:	29127-8585
Country	:	US
Telephone Number	:	803-445-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	TAYLOR AT MARION ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29220-0001
Country	:	US
Telephone Number	:	803-296-2276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	01/21/2021

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Directions to “ DONNA K BLAIR CRNA” Practice Location

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