Blazevich, Beth
Blazevich, Beth is an individual health care provider with primary practice located at 365 Montauk Ave , New London CT 06320-4700. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Neonatal, which is considered as her primary health care specialty. Blazevich, Beth can be contacted via phone (860) 442-0711.Contact Information
Primary practice address
365 Montauk Ave
New London CT 06320-4700
Phone: (860) 442-0711
Fax: (860) 271-4224
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Neonatal | 363LN0000X | 000492 | Connecticut |
Profile Details
| NPI number | 1629171848 |
|---|---|
| LBN Legal business name | Blazevich, Beth |
| Credentials | Advanced Practice Registered Nurse (APRN) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 6th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629171848 | NPPES |
| Connecticut | MEDICAID | 4014679 | |
| Connecticut | MEDICAID | 4024972 |
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