Individual
TRAVIS C BLACKHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
202 PROSPECT DR, GLENDIVE, MT 59330-1999
(406) 345-3306
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1253
(360) 729-3185
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
159520
MT
367500000X
Certified Registered Nurse Anesthetist
201402871CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
R51894
ND
367500000X
Certified Registered Nurse Anesthetist
SRA100081
CO
Other
Enumeration date
04/25/2012
Last updated
09/23/2025
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