MEDICARE: DANIELLE MICHELLE BLONSTEIN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	95019613	CA

General Provider Information

NPI Number	:	1033870985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MICHELLE BLONSTEIN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2109 J ST STE 301
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-4767
Country	:	US
Telephone Number	:	650-391-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 GIBSON DR STE 220
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5796
Country	:	US
Telephone Number	:	916-773-5577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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