Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP007894 | PA |
NPI | 1003859018 |
---|---|
Provider Name | Bryan Matthew Blanchard |
First Address | Philadelphia, PA 19106-3500 |
Second Address | Philadelphia, PA 19106-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 01/02/2013 |