Provider Demographics
NPI:1639504517
Name:BLANCHARD, ERIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E MICHIGAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1406
Mailing Address - Country:US
Mailing Address - Phone:571-205-7766
Mailing Address - Fax:517-205-7767
Practice Address - Street 1:100 E MICHIGAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1406
Practice Address - Country:US
Practice Address - Phone:157-120-5776
Practice Address - Fax:517-205-7766
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C00059OtherBCBS
MIMI7972002Medicare PIN