Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301109886 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301117006 | MI |
NPI | 1003265893 |
---|---|
Provider Name | Dr. Jennifer Blase |
First Address | Ann Arbor, MI 48109-5000 |
Second Address | Ann Arbor, MI 48109-5718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 15/09/2020 |