MEDICARE: TRISHA L BLIZZARD CLD (CBI), DIP CBED

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	374J00000X	Doula

General Provider Information

NPI Number	:	1629337050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA L BLIZZARD CLD (CBI), DIP CBED

Provider Business Mailing Address
First Line	:	4609 CATCHIN DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8249
Country	:	US
Telephone Number	:	817-226-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 CATCHIN DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8249
Country	:	US
Telephone Number	:	817-226-5475
Fax Number	:

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

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/04/2012

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