Provider Demographics
NPI:1346590346
Name:BLAZIER, SHELLY DAWN (RN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DAWN
Last Name:BLAZIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-8538
Mailing Address - Country:US
Mailing Address - Phone:303-646-2970
Mailing Address - Fax:
Practice Address - Street 1:252 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-2321
Practice Address - Country:US
Practice Address - Phone:719-346-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse