Provider Demographics
NPI:1073689865
Name:BLINN, LAUREY A (CRNA)
Entity Type:Individual
Prefix:
First Name:LAUREY
Middle Name:A
Last Name:BLINN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E THIRD S
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7806
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN46262163W00000X
TNAPN08979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3049756OtherBLUE CROSS BLUE SHIELD TN
GAN366479OtherWELLCARE (GA MEDICAID)
AL009932465Medicaid
GA000580577AMedicaid
TN430030817OtherRAILROAD MEDICARE
TN3602968Medicaid
NC8052434Medicaid
GAN366479OtherWELLCARE (GA MEDICAID)