Basic Information
Provider Information | |||||||||
NPI: | 1275689853 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BLUM | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | MAUREEN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | O'REILLY | ||||||||
OtherFirstName: | KAREN | ||||||||
OtherMiddleName: | MAUREEN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO DRAWER PH | ||||||||
Address2: |   | ||||||||
City: | CHINLE | ||||||||
State: | AZ | ||||||||
PostalCode: | 86503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9286747001 | ||||||||
FaxNumber: | 9286747705 | ||||||||
Practice Location | |||||||||
Address1: | 1000 GREENLEY RD | ||||||||
Address2: |   | ||||||||
City: | SONORA | ||||||||
State: | CA | ||||||||
PostalCode: | 953705200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2095365000 | ||||||||
FaxNumber: | 2095363514 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2007 | ||||||||
LastUpdateDate: | 07/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/18/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 95000712 | CA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.