Individual
CONSTANCE FAYE BLAISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-2200
(815) 971-9097
Mailing address
8158 ROYAL OAKS RD, ROCKFORD, IL 61107-2845
(815) 979-8723
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209018537
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588135529
—
WI
Enumeration date
12/17/2018
Last updated
08/28/2020
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