Provider Demographics
NPI:1982750477
Name:BLANKEMEIER, WILLIAM LEO (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEO
Last Name:BLANKEMEIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80160-0569
Mailing Address - Country:US
Mailing Address - Phone:720-283-0960
Mailing Address - Fax:720-283-3178
Practice Address - Street 1:2480 S DOWNING ST
Practice Address - Street 2:SUITE G20
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5890
Practice Address - Country:US
Practice Address - Phone:720-283-0960
Practice Address - Fax:720-283-3178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97347367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62038061Medicaid
COC802452Medicare PIN