Provider Demographics
NPI:1043259401
Name:BLUNT, ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLUNT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 IVINS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1906
Mailing Address - Country:US
Mailing Address - Phone:215-483-3162
Mailing Address - Fax:
Practice Address - Street 1:850 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1957
Practice Address - Country:US
Practice Address - Phone:215-769-1100
Practice Address - Fax:215-769-1117
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005980B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner