Basic Information
| Provider Information | |||||||||
| NPI: | 1376825919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOMFIELD | ||||||||
| FirstName: | CHRISTIANA | ||||||||
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| Credential: | FNP,CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 BLAIR PARK RD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | WILLISTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022881145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053017110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022583905 | ||||||||
| FaxNumber: | 8022584903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 06/07/2013 | ||||||||
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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 | 1010018856 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | 1010018856 | VT | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | OVN2519 | 05 | VT | MEDICAID |