Provider Demographics
NPI:1144572322
Name:PANCHECK, BLAIR NICOLE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:NICOLE
Last Name:PANCHECK
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8693 E PRIOR RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-9468
Mailing Address - Country:US
Mailing Address - Phone:810-287-7944
Mailing Address - Fax:810-733-7898
Practice Address - Street 1:1522 JANES AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-755-0316
Practice Address - Fax:989-755-0956
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229884363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health