MEDICARE: CATHERINE LEE BLASER RN, PHN, ACRN

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	163W00000X	Registered Nurse	768016	CA

General Provider Information

NPI Number	:	1316292782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LEE BLASER RN, PHN, ACRN

Provider Business Mailing Address
First Line	:	PO BOX 9215
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92169-0215
Country	:	US
Telephone Number	:	781-987-4541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1054 EMERALD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2814
Country	:	US
Telephone Number	:	781-987-4541
Fax Number	:

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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