1639296908 NPI number — MS. KRISTEN A BLANCHARD B.A.

Table of content: MS. KRISTEN A BLANCHARD B.A. (NPI 1639296908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639296908 NPI number — MS. KRISTEN A BLANCHARD B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHARD
Provider First Name:
KRISTEN
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639296908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 N ORANGE ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-2296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-656-4044
Provider Business Mailing Address Fax Number:
302-656-3439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 N ORANGE ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801-2296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-656-4044
Provider Business Practice Location Address Fax Number:
302-656-3439
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103TP2701X , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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