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General NPI Number Information
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NPI Number | 1205585742
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Entity Type | Individual
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Provider Name | ELISE R BLASEG MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1250 E 3900 S STE 260
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1371
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Country | US
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Telephone | 801-265-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 810
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City | HANOVER
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State | NH
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Zip | 03755-0810
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Country | US
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Telephone | 603-308-1467
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35012
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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