Provider Demographics
NPI:1023364445
Name:BLATTERT, SHARON KAY (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:BLATTERT
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30600 TELEGRAPH RD
Mailing Address - Street 2:SUITE 3275
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5718
Mailing Address - Country:US
Mailing Address - Phone:248-723-9613
Mailing Address - Fax:248-723-9615
Practice Address - Street 1:30600 TELEGRAPH RD
Practice Address - Street 2:SUITE 3275
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4530
Practice Address - Country:US
Practice Address - Phone:248-723-9613
Practice Address - Fax:248-723-9615
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704208896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner