MEDICARE: CHLOE BLANZY RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	4704403327	MI

General Provider Information

NPI Number	:	1407700701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOE BLANZY RN

Provider Business Mailing Address
First Line	:	8514 CAMELLIA ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-9635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 44TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-5002
Country	:	US
Telephone Number	:	616-243-6262
Fax Number	:	616-243-6969

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

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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