Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R191300 | MD |
NPI | 1003381641 |
---|---|
Provider Name | Alayna Marie Blazakis |
First Address | Baltimore, MD 21234-1111 |
Second Address | Baltimore, MD 21239-2945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |