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NPI Code Detail

MEDICARE: RAE JEAN BLASCHKA NP

MEDICARE: RAE JEAN BLASCHKA NP
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
1363L00000XNurse PractitionerNP7235AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093788994
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAE JEAN BLASCHKA NP
Provider Business Mailing Address
First Line : 1818 E REZANOF DR
Second Line :
City : KODIAK
State : AK
Zip : 99615-6505
Country : US
Telephone Number : 907-486-6065
Fax Number : 907-486-2248
Provider Business Practice Location Address
First Line : 1818 E REZANOF DR
Second Line :
City : KODIAK
State : AK
Zip : 99615-6505
Country : US
Telephone Number : 907-486-6065
Fax Number : 907-486-2248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 07/08/2007

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