Provider Demographics
NPI:1922089861
Name:BLAEMIRE, EVELYN (CRNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BLAEMIRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:YANG
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8129 SEA WATER PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2882
Mailing Address - Country:US
Mailing Address - Phone:410-799-0642
Mailing Address - Fax:410-630-3838
Practice Address - Street 1:7350 GRACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2470
Practice Address - Country:US
Practice Address - Phone:410-799-0642
Practice Address - Fax:410-630-3838
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR094362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32450Medicare UPIN