Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00075500 | NJ |
NPI | 1023238821 |
---|---|
Provider Name | Angela Blomquist |
First Address | Marlton, NJ 08053-4112 |
Second Address | Haddon Heights, NJ 08035-1909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 16/09/2010 |