Healthcare Provider Details

I. General information

NPI: 1346444346
Provider Name (Legal Business Name): MONICA F. BLAISDELL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 D ST
MERCED CA
95340-6248
US

IV. Provider business mailing address

3431 BEALS CT
MERCED CA
95348-2804
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-7551
  • Fax: 209-725-7556
Mailing address:
  • Phone: 209-722-8234
  • Fax: 209-722-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberE205514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: