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General NPI Number Information
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NPI Number | 1700993201
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Entity Type | Individual
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Provider Name | ROBERTA F BLASENAK RN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 801 MIDDLE CREEK RD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5018
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Country | US
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Telephone | 865-453-4434
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Fax | 865-428-3508
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Provider Business Mailing Address
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Address Line | 4559 WHETSTONE RD
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City | SEVIERVILLE
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State | TN
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Zip | 37862-8195
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Country | US
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Telephone | 865-774-6471
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4072466
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License Number State | TN
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