Provider Demographics
NPI:1275689853
Name:BLUM, KAREN MAUREEN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MAUREEN
Last Name:BLUM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:MAUREEN
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO DRAWER PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7001
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:1000 GREENLEY RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5200
Practice Address - Country:US
Practice Address - Phone:209-536-5000
Practice Address - Fax:209-536-3514
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000712367500000X
WY18761.694367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered