Provider Demographics
NPI:1174922280
Name:BLANCHARD, MICHAEL C (RN, APNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:RN, APNP
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Other - First Name:
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Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:POB SUITE 403
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-5973
Mailing Address - Fax:262-549-0648
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:POB SUITE 403
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-5973
Practice Address - Fax:262-549-0648
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3973-33363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400243178Medicare PIN