Provider Demographics
NPI:1093402604
Name:BLASIUS, EMMA (RN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BLASIUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 ROUTE 474
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9637
Mailing Address - Country:US
Mailing Address - Phone:716-720-1161
Mailing Address - Fax:
Practice Address - Street 1:880 E 2ND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-3824
Practice Address - Country:US
Practice Address - Phone:716-485-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY795090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse