Individual
WAYDE RUSSELL BLUMHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1825 LOGAN AVE, WATERLOO, IA 50703
(319) 235-3886
(319) 233-1630
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 235-5390
(319) 233-1630
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D-074832
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2062018
—
IA
05
—
3062018
—
IA
01
—
42141730780
JOHN DEERE HEALTH INS
IA
01
—
55001
WELLMARK INS PLAN
IA
Enumeration date
05/18/2006
Last updated
12/10/2007
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