Healthcare Provider Details

I. General information

NPI: 1538126982
Provider Name (Legal Business Name): TONI ANN BLAZEK PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6275
  • Fax: 402-559-7062
Mailing address:
  • Phone: 402-559-6275
  • Fax: 402-559-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number110344
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: