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Individual

BETH BLAZEVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 271-4224
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 271-4224

Taxonomy

Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
000492
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4014679
CT
05
4024972
CT
Enumeration date
09/06/2006
Last updated
07/09/2007
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