Provider Demographics
NPI:1285189894
Name:BLANCHARD, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1968 ROGSTAD POWERLINE RD # 218
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:ID
Mailing Address - Zip Code:83804-4924
Mailing Address - Country:US
Mailing Address - Phone:208-610-5712
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000464367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered