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General NPI Number Information
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NPI Number | 1477934875
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Entity Type | Individual
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Provider Name | JODI BLAZEL ANP-C
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 22335 EXPLORATION DR STE 2005
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-2015
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Country | US
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Telephone | 301-863-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 22335 EXPLORATION DR STE 2005
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-2015
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Country | US
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Telephone | 301-863-7310
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R203482
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License Number State | MD
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