Provider Demographics
NPI:1336902725
Name:BLATHRAS, VALERIE (CNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BLATHRAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BOWER RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1536
Mailing Address - Country:US
Mailing Address - Phone:781-389-0508
Mailing Address - Fax:
Practice Address - Street 1:25 ADAMS ST STE 100
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1919
Practice Address - Country:US
Practice Address - Phone:781-795-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282234363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health