Provider Demographics
NPI:1235547563
Name:BLADH-SILVERSTEIN, KIM CHARLOTTA (FNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CHARLOTTA
Last Name:BLADH-SILVERSTEIN
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 1:631B NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4102
Mailing Address - Country:US
Mailing Address - Phone:413-499-2051
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240
Practice Address - Country:US
Practice Address - Phone:413-344-1700
Practice Address - Fax:413-728-8790
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily