Provider Demographics
NPI:1053733865
Name:BLACKSTONE, MAUREEN (CRNA)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BLACKSTONE
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:HAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34490 RIDGE RD APT 111
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3033
Mailing Address - Country:US
Mailing Address - Phone:440-477-0796
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:440-477-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15488-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered