Individual
ROBIN MADONNA BLAIZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 VERNON BLVD, ASTORIA, NY 11106-5121
(844) 815-1508
Mailing address
518 BEACH 32ND ST, FAR ROCKAWAY, NY 11691-1933
(347) 933-8383
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
755337
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404761
NY
Other
Enumeration date
01/21/2022
Last updated
07/06/2023
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