Provider Demographics
NPI:1407842545
Name:BLOSCHOCK, RHONDA CAROLYN (CRNA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:CAROLYN
Last Name:BLOSCHOCK
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 102966
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2966
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-737-2271
Practice Address - Street 1:1133 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5085
Practice Address - Country:US
Practice Address - Phone:678-604-1053
Practice Address - Fax:678-604-5548
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN096667367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA450540616BMedicaid
GA43BBBZHMedicare PIN
GAR11513Medicare UPIN