Provider Demographics
NPI:1467763821
Name:BLAKELY-EWART, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BLAKELY-EWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ELDERT LN
Mailing Address - Street 2:APT 8R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4753
Mailing Address - Country:US
Mailing Address - Phone:718-277-0234
Mailing Address - Fax:
Practice Address - Street 1:790 ELDERT LN
Practice Address - Street 2:APT 8R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4753
Practice Address - Country:US
Practice Address - Phone:718-277-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3279251163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool