Provider Demographics
NPI:1811055676
Name:BLAZAR, NANCY ERSKINE (RD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ERSKINE
Last Name:BLAZAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:23875 COMMERCE PARK DR.
Mailing Address - Street 2:SUITE # 160
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-577-4226
Mailing Address - Fax:216-378-8900
Practice Address - Street 1:23875 COMMERCE PARK DR.
Practice Address - Street 2:SUITE # 160
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-577-4226
Practice Address - Fax:216-378-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLD5015OtherOHIO BOARD OF DIETETICS
OHR468862OtherAMERICAN DIETETIC ASSOCIA