Provider Demographics
NPI:1710278288
Name:BLATT, JAMIE ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANN
Last Name:BLATT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 DORN RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-4077
Mailing Address - Country:US
Mailing Address - Phone:814-449-7209
Mailing Address - Fax:
Practice Address - Street 1:312 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2624
Practice Address - Country:US
Practice Address - Phone:814-452-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN575336367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered