Provider Demographics
NPI:1588174502
Name:BLAISE, LEOPOLDINE (DNP)
Entity type:Individual
Prefix:
First Name:LEOPOLDINE
Middle Name:
Last Name:BLAISE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3260
Mailing Address - Country:US
Mailing Address - Phone:816-421-3700
Mailing Address - Fax:816-421-1654
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-1654
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78459-032363L00000X
CT10630363L00000X, 363LF0000X
NY351766363L00000X
MO2017033175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner