Provider Demographics
NPI:1306990320
Name:BLOSZINSKY, MELODIE (RN)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:BLOSZINSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CLINTON TER
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7618
Mailing Address - Country:US
Mailing Address - Phone:610-905-0157
Mailing Address - Fax:610-250-4938
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:610-250-4797
Practice Address - Fax:610-250-4938
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN31291L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016554930001Medicaid