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NPI Code Detail

MEDICARE: MS. ANNETTE WALBLAY N.P.

MEDICARE: MS. ANNETTE WALBLAY N.P.
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
1363L00000XNurse Practitioner4704155767MI
2363LA2200XAdult Health Nurse Practitioner4704155767MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25008601210OTHERMIBLUECROSSBLUESHIELD OF MI

General Provider Information

NPI Number : 1417983818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNETTE WALBLAY N.P.
Provider Business Mailing Address
First Line : 3621 S STATE STREET
Second Line : 700 KMS PLACE
City : ANN ARBOR
State : MI
Zip : 48108
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 1500 EAST MEDICAL CENTER DRIVE
Second Line : LEVEL 3
City : ANN ARBOR
State : MI
Zip : 48109-5856
Country : US
Telephone Number : 888-287-1082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 01/02/2009

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