Provider Demographics
NPI:1891502167
Name:BLAISE, MARIE G
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:G
Last Name:BLAISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 JAMESTOWN LN APT 8208
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6182
Mailing Address - Country:US
Mailing Address - Phone:321-614-7270
Mailing Address - Fax:
Practice Address - Street 1:1865 JAMESTOWN LN APT 8208
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6182
Practice Address - Country:US
Practice Address - Phone:321-614-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter