Provider Demographics
NPI:1598849523
Name:BLECK, MICHELLE M (CFNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:BLECK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2032
Mailing Address - Country:US
Mailing Address - Phone:508-486-9593
Mailing Address - Fax:508-429-7913
Practice Address - Street 1:100 JEFFREY AVE
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2028
Practice Address - Country:US
Practice Address - Phone:508-429-2800
Practice Address - Fax:508-429-7913
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily