Provider Demographics
NPI:1912265943
Name:BLANCHETTE, ERIN FAVRE (CPNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:FAVRE
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BLUE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2834
Mailing Address - Country:US
Mailing Address - Phone:228-467-1320
Mailing Address - Fax:
Practice Address - Street 1:618 BLUE MEADOW RD
Practice Address - Street 2:CHILDREN'S INTERNATIONAL MEDICAL GROUP
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2834
Practice Address - Country:US
Practice Address - Phone:228-467-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870090363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics