Healthcare Provider Details

I. General information

NPI: 1982837233
Provider Name (Legal Business Name): PATRICIA V BLANC NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 HONEYSPOT RD
STRATFORD CT
06615-7172
US

IV. Provider business mailing address

982 E MAIN ST
BRIDGEPORT CT
06608-1913
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-7242
  • Fax: 203-375-2318
Mailing address:
  • Phone: 203-696-3260
  • Fax: 203-375-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004186
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: