Provider Demographics
NPI:1457653982
Name:DREAMWORKS ANESTHESIA, INC
Entity Type:Organization
Organization Name:DREAMWORKS ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NURSE ANESTHETIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP, CRNA
Authorized Official - Phone:804-794-0604
Mailing Address - Street 1:11950 SILBYRD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2139
Mailing Address - Country:US
Mailing Address - Phone:804-794-0604
Mailing Address - Fax:804-794-0604
Practice Address - Street 1:11950 SILBYRD DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2139
Practice Address - Country:US
Practice Address - Phone:804-794-0604
Practice Address - Fax:804-794-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24164241367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932103884Medicaid