Provider Demographics
NPI:1568627735
Name:BLASE, MARY HOPE (APRN CNS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HOPE
Last Name:BLASE
Suffix:
Gender:F
Credentials:APRN CNS
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:HOPE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:2100 PENNSYLVANIA AVE NW STE W
Practice Address - Street 2:KAISER PERMANENTE WEST END MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3227
Practice Address - Country:US
Practice Address - Phone:202-872-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000690163WP0809X
MDAC000548163WP0809X
DCRN1013292364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult