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NPI Code Detail

MEDICARE: JOEL GREGORY BLASCHE NP

MEDICARE:   JOEL GREGORY BLASCHE  NP
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
1363LF0000XFamily Nurse PractitionerRN149466GA

General Provider Information

NPI Number : 1720526346
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL GREGORY BLASCHE NP
Provider Business Mailing Address
First Line : 170 PARKMONT CT
Second Line :
City : DALLAS
State : GA
Zip : 30132-1126
Country : US
Telephone Number : 478-319-1831
Fax Number :
Provider Business Practice Location Address
First Line : 170 PARKMONT CT
Second Line :
City : DALLAS
State : GA
Zip : 30132-1126
Country : US
Telephone Number : 478-319-1831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2017
Last Update Date : 02/02/2017

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