Provider Demographics
NPI:1427152453
Name:BLANKENSHIP, THRESIA LYNN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:THRESIA
Middle Name:LYNN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 VERANDA TRCE
Mailing Address - Street 2:
Mailing Address - City:HOKES BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35903-7382
Mailing Address - Country:US
Mailing Address - Phone:256-494-1590
Mailing Address - Fax:
Practice Address - Street 1:418 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5102
Practice Address - Country:US
Practice Address - Phone:256-543-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-051907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR37113Medicare UPIN