Provider Demographics
NPI:1073643458
Name:BLATT, MOLLY ELIZABETH (CNP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:BLATT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 636799
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6799
Mailing Address - Country:US
Mailing Address - Phone:513-569-6422
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:3219 CLIFTON AVE STE 315
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3047
Practice Address - Country:US
Practice Address - Phone:513-624-0934
Practice Address - Fax:513-624-0999
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09335363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP-09335OtherNURSE PRACTITIONER LICENS
OHRX 09335 - EX1OtherCERTIFICATE TO PRESCRIBE
OH2923733Medicaid
OHRN 231051OtherRN LICENSE
OHH183020Medicare PIN