Provider Demographics
NPI:1962471888
Name:BLACKSTONE, KARMEN K (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KARMEN
Middle Name:K
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 THOMAS POINT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3911
Mailing Address - Country:US
Mailing Address - Phone:207-442-0325
Mailing Address - Fax:207-443-4578
Practice Address - Street 1:14 THOMAS POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3911
Practice Address - Country:US
Practice Address - Phone:207-442-0325
Practice Address - Fax:207-443-4578
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER043926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2676600Medicaid
MEP15148Medicare UPIN
ME2676600Medicaid
ME1006390001Medicare NSC