Provider Demographics
NPI:1023199361
Name:BLATNIK, VALERIE LYNN (NP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:BLATNIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10006 CHIMNEY DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6898
Mailing Address - Country:US
Mailing Address - Phone:704-256-3300
Mailing Address - Fax:
Practice Address - Street 1:10006 CHIMNEY DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6898
Practice Address - Country:US
Practice Address - Phone:704-256-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5734363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1401Medicaid
SCAA3632Medicare PIN