Provider Demographics
NPI:1710276357
Name:BLAZER, LEAH PARRISH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:PARRISH
Last Name:BLAZER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 BROCKENFELT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9122
Mailing Address - Country:US
Mailing Address - Phone:704-807-5678
Mailing Address - Fax:
Practice Address - Street 1:295A MIDLAND PKWY STE 140
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5901
Practice Address - Country:US
Practice Address - Phone:843-695-2727
Practice Address - Fax:843-695-2728
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15655363LA2100X
SC23286363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care