MEDICARE: SANDRA SLOANE BLIX 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	4704176326	MI

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	:	1982679080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SLOANE BLIX CRNA

Provider Business Mailing Address
First Line	:	31 N SAINT JOSEPH AVE
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-2207
Country	:	US
Telephone Number	:	269-687-1879
Fax Number	:	269-683-0104

Provider Business Practice Location Address
First Line	:	31 N SAINT JOSEPH AVE
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-2207
Country	:	US
Telephone Number	:	269-687-1879
Fax Number	:	269-683-0104

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	12/10/2019

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