1467432153 NPI number — MS. JOAN M BLASINSKY CRNA

Table of content: MS. JOAN M BLASINSKY CRNA (NPI 1467432153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467432153 NPI number — MS. JOAN M BLASINSKY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLASINSKY
Provider First Name:
JOAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467432153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6332 OYSTER BAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15017-3421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-285-3960
Provider Business Mailing Address Fax Number:
412-221-7577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2969 SE LEXINGTON LAKES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-285-3960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN238035L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 61203 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RN3138002 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00384412 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2734072 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304073900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810008523 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 976602200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019734030004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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