Provider Demographics
NPI:1427758242
Name:BLATZ, LEO RAPHAEL (RN)
Entity type:Individual
Prefix:MR
First Name:LEO
Middle Name:RAPHAEL
Last Name:BLATZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:2829 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9420
Mailing Address - Country:US
Mailing Address - Phone:668-633-3700
Mailing Address - Fax:877-375-2450
Practice Address - Street 1:2829 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9420
Practice Address - Country:US
Practice Address - Phone:668-633-3700
Practice Address - Fax:877-375-2450
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY273546163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health