Healthcare Provider Details

I. General information

NPI: 1275587701
Provider Name (Legal Business Name): MARVEL JEAN BLAZEK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 SE KENT ST
GREENFIELD IA
50849-9454
US

IV. Provider business mailing address

609 SE KENT ST
GREENFIELD IA
50849-9454
US

V. Phone/Fax

Practice location:
  • Phone: 641-743-6189
  • Fax: 641-743-6217
Mailing address:
  • Phone: 641-743-2123
  • Fax: 641-743-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA047506
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: