Basic Information
| Provider Information | |||||||||
| NPI: | 1235547563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLADH-SILVERSTEIN | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | CHARLOTTA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 631B NORTH ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134992051 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 PITTSFIELD RD | ||||||||
| Address2: | |||||||||
| City: | LENOX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133441700 | ||||||||
| FaxNumber: | 4137288790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN266519 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.