Individual
BETTY ANN BLASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
971 LAKELAND DR STE 1250, JACKSON, MS 39216-4609
(601) 366-1011
(601) 366-7311
Mailing address
971 LAKELAND DR STE 1250, JACKSON, MS 39216-4609
(601) 366-1011
(601) 366-7311
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R529435
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R529435
FNP LICENSE
MS
Enumeration date
11/17/2006
Last updated
07/08/2007
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