Provider Demographics
NPI:1134563539
Name:BLATZ, SANDRA YVONNE (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVONNE
Last Name:BLATZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:YVONNE
Other - Last Name:KITKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7535 WINDSOR DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18195
Mailing Address - Country:US
Mailing Address - Phone:610-336-8000
Mailing Address - Fax:610-336-8001
Practice Address - Street 1:7535 WINDSOR DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18195
Practice Address - Country:US
Practice Address - Phone:610-336-8000
Practice Address - Fax:610-336-8001
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007414363L00000X
NJ2014019311363L00000X
PASPOO7414364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101804Medicaid