Provider Demographics
NPI:1427480045
Name:BLANCHETTE, ANDREW THOMAS (CRNA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:BLANCHETTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 W CLAIREMONT AVE
Mailing Address - Street 2:STE 2C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4503
Mailing Address - Country:US
Mailing Address - Phone:715-834-8721
Mailing Address - Fax:715-834-8721
Practice Address - Street 1:1101 W CLAIREMONT AVE
Practice Address - Street 2:STE 2C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4503
Practice Address - Country:US
Practice Address - Phone:715-834-8721
Practice Address - Fax:715-834-8721
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156912-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered