Provider Demographics
NPI:1346353513
Name:WEST, BLAINE MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:MICHAEL
Last Name:WEST
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-564-7743
Mailing Address - Fax:
Practice Address - Street 1:4600 38TH STREET
Practice Address - Street 2:COLUMBUS COMMUNITY HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-564-7118
Practice Address - Fax:402-562-3376
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE023069367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10200OtherMIDLANDS
NE277095OtherCOVENTRY
NEP00124183OtherRAILROAD
NE277095OtherCOVENTRY
NEP00124183OtherRAILROAD