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NPI Code Detail

MEDICARE: LISA DIANE BLACKETTER CRNA

MEDICARE: LISA DIANE BLACKETTER 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
1367500000XCertified Registered Nurse Anesthetist209010216IL

General Provider Information

NPI Number : 1851630040
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DIANE BLACKETTER CRNA
Provider Business Mailing Address
First Line : 2701 HOSPITAL DR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-5749
Country : US
Telephone Number : 361-573-9181
Fax Number : 361-582-5743
Provider Business Practice Location Address
First Line : 2701 HOSPITAL DR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-5749
Country : US
Telephone Number : 361-573-9181
Fax Number : 361-582-5743
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2013
Last Update Date : 10/10/2024

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Directions to “ LISA DIANE BLACKETTER CRNA” Practice Location

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