Provider Demographics
NPI:1114548690
Name:BLAGUSKI, REBECCA (CERTIFIED REGISTERED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BLAGUSKI
Suffix:
Gender:F
Credentials:CERTIFIED REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 LUDLOW STREET
Mailing Address - Street 2:APARTMENT 2406
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:905-531-0611
Mailing Address - Fax:
Practice Address - Street 1:THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
Practice Address - Street 2:3400 SPRUCE STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-316-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2022-07-18
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-07-18
Provider Licenses
StateLicense IDTaxonomies
PARN719286163W00000X
PASP021361363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care