Provider Demographics
NPI:1760037766
Name:BLINOV, ANYA (CRNA)
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:BLINOV
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:ILLYUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:LOCHBUIE
Mailing Address - State:CO
Mailing Address - Zip Code:80603-5864
Mailing Address - Country:US
Mailing Address - Phone:134-548-9304
Mailing Address - Fax:
Practice Address - Street 1:3911 AMBROSIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3888
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-768-8774
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030282367500000X
COAPN.0998067-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered