Provider Demographics
NPI:1801160510
Name:BLANEY, MARTIN R II (DNAP, APRN-CRNA)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:BLANEY
Suffix:II
Gender:M
Credentials:DNAP, APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JONES RD
Mailing Address - Street 2:
Mailing Address - City:TRESCOTT TWP
Mailing Address - State:ME
Mailing Address - Zip Code:04652-5200
Mailing Address - Country:US
Mailing Address - Phone:207-415-4594
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA123001367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MER046439OtherMAINE NURSING LICENSE