Provider Demographics
NPI:1760445795
Name:BLAIR, DONNA K (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:K
Other - Last Name:BOBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2543 BACHMAN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-8585
Mailing Address - Country:US
Mailing Address - Phone:803-445-4220
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR AT MARION ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN295367500000X
NC2559367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0698Medicaid
SCAN0698Medicaid