Healthcare Provider Details

I. General information

NPI: 1508943341
Provider Name (Legal Business Name): VIRGINIA BLONDIN RICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

3 SPRUCE TREE LN
WAYLAND MA
01778-1215
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6421
  • Fax: 617-730-0194
Mailing address:
  • Phone: 508-358-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number115713
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: