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General NPI Number Information
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NPI Number | 1730345406
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Entity Type | Individual
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Provider Name | BONNIE ROSE BLASS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 241 N MAIN ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-2219
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Country | US
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Telephone | 978-840-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 673 SOUTH ST
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City | SHREWSBURY
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State | MA
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Zip | 01545-4807
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Country | US
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Telephone | 856-417-5458
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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