Provider Demographics
NPI:1285216523
Name:DIEUJUSTE, BLONDINE (CRNA)
Entity Type:Individual
Prefix:DR
First Name:BLONDINE
Middle Name:
Last Name:DIEUJUSTE
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 1:2121 FERNBANK WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2472
Mailing Address - Country:US
Mailing Address - Phone:678-697-6565
Mailing Address - Fax:
Practice Address - Street 1:10800 MIDLOTHIAN TPKE STE 265
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4700
Practice Address - Country:US
Practice Address - Phone:804-594-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95140069163WC0200X
GARN245825163WC0200X
VA0024181576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine