Provider Demographics
NPI:1619178035
Name:BLASA, CORI L (RN)
Entity Type:Individual
Prefix:MS
First Name:CORI
Middle Name:L
Last Name:BLASA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11140 S TOWNE SQUARE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123
Mailing Address - Country:US
Mailing Address - Phone:314-894-0787
Mailing Address - Fax:314-729-3963
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:#301 GATEWAY CARDIOLOGY PC
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-729-0088
Practice Address - Fax:314-729-3974
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO149338163W00000X
IL41307283163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149338OtherRN LIC
IL41307283OtherRN LIC