Individual
TRAVIS LEE BLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
459794
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
RN.459794
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15492136
CAQH
—
01
—
PENDING
MEDICARE PTAN
OH
05
—
PENDING
—
OH
Enumeration date
06/30/2021
Last updated
01/24/2022
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