Individual
MS. CARRIE M. BLASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2817
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000810765898
PHCS
—
05
—
41278800
—
WI
Enumeration date
11/16/2006
Last updated
02/17/2010
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