Healthcare Provider Details

I. General information

NPI: 1710276357
Provider Name (Legal Business Name): LEAH PARRISH BLAZER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E 7TH ST STE 100
CHARLOTTE NC
28204-4319
US

IV. Provider business mailing address

1423 BROCKENFELT DR
CHARLESTON SC
29414-9122
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-9484
  • Fax:
Mailing address:
  • Phone: 704-807-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15655
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5021356
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23286
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: