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General NPI Number Information
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NPI Number | 1134755911
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Entity Type | Individual
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Provider Name | COREY ALLEN BLASSIE NP
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Gender | Male
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 122 HERON CT
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City | SAINT PETERS
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State | MO
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Zip | 63376-5038
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Country | US
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Telephone | 636-542-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-575-1374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2019046619
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License Number State | MO
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