Provider Demographics
NPI:1356616981
Name:BLUMMER, CELINE D (CRNA)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:D
Last Name:BLUMMER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CELINE
Other - Middle Name:
Other - Last Name:VIDAURRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:1000 CARONDELET DRIVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-942-4400
Practice Address - Fax:954-514-3979
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9292170367500000X
MO2012011744367500000X
MO2012008494367500000X
OK105015367500000X
IA113560367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered