Individual
MONICA BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DRIVE #258, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1047367
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000288565
BLUE SHIELD
—
05
—
200416410
—
IN
05
—
2380963
—
OH
05
—
74476144
—
KY
Enumeration date
12/07/2005
Last updated
08/28/2012
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