Provider Demographics
NPI:1942411848
Name:BLANKENSHIP, JASON ANTHONY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:BLANKENSHIP
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2409
Mailing Address - Country:US
Mailing Address - Phone:360-748-8632
Mailing Address - Fax:360-748-3869
Practice Address - Street 1:2205 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3252
Practice Address - Country:US
Practice Address - Phone:360-694-2544
Practice Address - Fax:360-694-1356
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200440093RN163WC0200X
OR201160007CRNA367500000X
ID63699367500000X
WAAP60800275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016141Medicaid
WAG8988520OtherMEDICARE WA
WAG8988521OtherMEDICARE WA
OR500632648Medicaid
WAG8988519OtherMEDICARE WA
WAG8988518OtherMEDICARE WA
ORR206321OtherMEDICARE OR