Healthcare Provider Details

I. General information

NPI: 1922422781
Provider Name (Legal Business Name): LEE ANN BLAZEJEWSKI MPH, MBA, BSRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 LINCOLN ST.
HOWELL MI
48843
US

IV. Provider business mailing address

209 LINCOLN ST.
HOWELL MI
48843
US

V. Phone/Fax

Practice location:
  • Phone: 517-579-2343
  • Fax:
Mailing address:
  • Phone: 517-579-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704299258
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number4704299258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: