MEDICARE: HAYLIE CHRISTINE BLOSSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1043070667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLIE CHRISTINE BLOSSER

Provider Business Mailing Address
First Line	:	8347 SMARTSVILLE RD
Second Line	:
City	:	SMARTSVILLE
State	:	CA
Zip	:	95977-9701
Country	:	US
Telephone Number	:	530-913-2533
Fax Number	:

Provider Business Practice Location Address
First Line	:	8347 SMARTSVILLE RD
Second Line	:
City	:	SMARTSVILLE
State	:	CA
Zip	:	95977-9701
Country	:	US
Telephone Number	:	530-913-2533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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Directions to “ HAYLIE CHRISTINE BLOSSER ” Practice Location

Language	Start Address	Practice Location

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