Individual
DAVID LEE BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
909 PARK ST, TRINIDAD, CO 81082-2312
(303) 550-0888
Mailing address
909 PARK ST, TRINIDAD, CO 81082-2312
(303) 550-0888
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 77277
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
0001300
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24927244
—
CO
Enumeration date
04/25/2007
Last updated
08/30/2016
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