Provider Demographics
NPI:1932425139
Name:BLASZAK, FAYE H (NP)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:H
Last Name:BLASZAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:BON SECOURS NEUROLOGY
Practice Address - Street 2:801 ROPER CREEK DRIVE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6938
Practice Address - Country:US
Practice Address - Phone:864-516-1170
Practice Address - Fax:877-249-9483
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4179363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1604Medicaid
SCAPPROVEDMedicaid