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General NPI Number Information
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NPI Number | 1881786879
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Entity Type | Individual
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Provider Name | DANIEL ANTHONY BLAZ FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 431 MEADOWLARK ST
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City | SHAW AFB
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State | SC
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Zip | 29152-5019
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Country | US
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Telephone | 803-885-7976
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Fax |
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Provider Business Mailing Address
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Address Line | 431 MEADOWLARK ST
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City | SHAW AFB
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State | SC
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Zip | 29152-5019
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Country | US
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Telephone | 330-858-3514
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN279151
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 09219
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License Number State | OH
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