Individual
COREY ALLEN BLASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
122 HERON CT, SAINT PETERS, MO 63376-5038
(636) 542-2552
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 575-1374
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2019046619
MO
Other
Enumeration date
03/12/2020
Last updated
11/17/2023
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