Provider Demographics
NPI:1598201329
Name:BLATCHLEY, KRISTIN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BLATCHLEY
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 1:41 MOHAWK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1000
Mailing Address - Country:US
Mailing Address - Phone:516-474-0427
Mailing Address - Fax:
Practice Address - Street 1:41 MOHAWK AVE APT 1
Practice Address - Street 2:
Practice Address - City:EAST ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1000
Practice Address - Country:US
Practice Address - Phone:516-474-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707007163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse