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General NPI Number Information
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NPI Number | 1619067568
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Entity Type | Individual
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Provider Name | SALLY ANN BLOMGREN R.N. M.S. C.S.
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 78 BURNCOAT ST
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City | WORCESTER
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State | MA
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Zip | 01605-1350
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Country | US
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Telephone | 508-414-5469
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Fax | 508-870-7684
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Provider Business Mailing Address
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Address Line | 78 BURNCOAT ST
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City | WORCESTER
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State | MA
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Zip | 01605-1350
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Country | US
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Telephone | 508-414-5469
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Fax | 508-870-7684
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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 | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 151021
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License Number State | MA
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