Provider Demographics
NPI:1205464674
Name:BLANTIN, CAREN B
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:B
Last Name:BLANTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40047 WELD COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610
Mailing Address - Country:US
Mailing Address - Phone:970-658-9269
Mailing Address - Fax:
Practice Address - Street 1:40047 WELD COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:AULT
Practice Address - State:CO
Practice Address - Zip Code:80610
Practice Address - Country:US
Practice Address - Phone:970-658-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026586363L00000X
COAPN.0995506-NP363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health