Basic Information
| Provider Information | |||||||||
| NPI: | 1396789954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUM | ||||||||
| FirstName: | THERESSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HIGHLAND DR | ||||||||
| Address2: | SUITE 624 | ||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092671178 | ||||||||
| FaxNumber: | 6092652054 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HIGHLAND DR | ||||||||
| Address2: | SUITE 624 | ||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092671178 | ||||||||
| FaxNumber: | 6092652054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00164700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.