Provider Demographics
NPI:1023667649
Name:BLATZER, LEAH (NP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BLATZER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 MARSHALL RUN CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5863
Mailing Address - Country:US
Mailing Address - Phone:614-634-3726
Mailing Address - Fax:
Practice Address - Street 1:4510 MARSHALL RUN CIR APT 204
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5863
Practice Address - Country:US
Practice Address - Phone:614-634-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily