MEDICARE: RUSTY HUGH BLEDSOE 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	780156	TX

General Provider Information

NPI Number	:	1871153122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSTY HUGH BLEDSOE CRNA

Provider Business Mailing Address
First Line	:	PSC 482 BOX 2778
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362-0028
Country	:	US
Telephone Number	:	903-331-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	CHATAN, NAKAGAMI DISTRICT
Second Line	:
City	:	OKINAWA
State	:	OKINAWA
Zip	:	9040103
Country	:	JP
Telephone Number	:	903-331-2708
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	07/21/2022

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