Provider Demographics
NPI:1689732349
Name:BLASE, TERRI L (MS)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BLASE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-4164
Mailing Address - Fax:402-559-6688
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-4164
Practice Address - Fax:402-559-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS