MEDICARE: MRS. DIANA CAROLE 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	134354	OH

General Provider Information

NPI Number	:	1972519866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA CAROLE BLAIR CRNA

Provider Business Mailing Address
First Line	:	3590 ROUND BOTTOM RD
Second Line	:	PMB123499
City	:	CINCINNATI
State	:	OH
Zip	:	45244-3026
Country	:	US
Telephone Number	:	239-470-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WYOMING ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-208-4380
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/04/2026

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