Provider Demographics
NPI:1003859018
Name:BLANCHARD, BRYAN MATTHEW (CRNP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-8713
Mailing Address - Fax:
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007894363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care