Healthcare Provider Details

I. General information

NPI: 1639144421
Provider Name (Legal Business Name): PATRICIA RYAN-BLANCHARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LONG POND DRIVE
HARWICH MA
02645
US

IV. Provider business mailing address

25 COMMUNICATIONS WAY MACC - REVENUE CYCLE
HYANNIS MA
02601-1866
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-4100
  • Fax: 508-432-8951
Mailing address:
  • Phone: 508-957-8664
  • Fax: 508-957-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number161231
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: