Provider Demographics
NPI:1144414418
Name:BLAZEY, MEGHAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:BLAZEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BONNIE BRAE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2135
Mailing Address - Country:US
Mailing Address - Phone:716-479-8948
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE BOX SON
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-5418
Practice Address - Country:US
Practice Address - Phone:716-479-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335216363LF0000X
MARN22635365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily