Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 5734 | TN |
NPI | 1023199361 |
---|---|
Provider Name | Valerie Lynn Blatnik |
First Address | Waxhaw, NC 28173-6898 |
Second Address | Waxhaw, NC 28173-6898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP1401 | (05) | SC |