Provider Demographics
NPI:1003696550
Name:BLOCKER, ELIZABETH (WHNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:WHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SAINT JOHN ST # 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2534
Mailing Address - Country:US
Mailing Address - Phone:347-721-6962
Mailing Address - Fax:
Practice Address - Street 1:42 SAINT JOHN ST # 2
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2534
Practice Address - Country:US
Practice Address - Phone:347-721-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2361528163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse