Provider Demographics
NPI:1346258357
Name:BLANCHARD, DEBORA ANN (CPNP APN)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ANN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:CPNP APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 EMMANS RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836
Mailing Address - Country:US
Mailing Address - Phone:973-584-1748
Mailing Address - Fax:
Practice Address - Street 1:125 ROUTE 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-691-9400
Practice Address - Fax:973-691-3283
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00068300364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics