Provider Demographics
NPI:1346415221
Name:BLASI, JENNA LYN (NMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LYN
Last Name:BLASI
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:BLASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NMD
Mailing Address - Street 1:60 LAFAYETTE ST
Mailing Address - Street 2:UNIVERSITY OF BRIDGEPORT COLLEGE NATUROPATHIC MEDICINE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604
Mailing Address - Country:US
Mailing Address - Phone:203-576-4124
Mailing Address - Fax:
Practice Address - Street 1:60 LAFAYETTE
Practice Address - Street 2:UNIVERSITY OF BRIDGEPORT COLLEGE OF NATUROPATHIC MEDICI
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604
Practice Address - Country:US
Practice Address - Phone:203-576-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000381175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath