Basic Information
Provider Information | |||||||||
NPI: | 1841384666 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BLANCHARD | ||||||||
FirstName: | GAIL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 70 MAIN ST | ||||||||
Address2: | NORTHAMPTON HEALTH CENTER | ||||||||
City: | FLORENCE | ||||||||
State: | MA | ||||||||
PostalCode: | 010621466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135868400 | ||||||||
FaxNumber: | 4135855435 | ||||||||
Practice Location | |||||||||
Address1: | 70 MAIN ST | ||||||||
Address2: | NORTHAMPTON HEALTH CENTER | ||||||||
City: | FLORENCE | ||||||||
State: | MA | ||||||||
PostalCode: | 010621466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135868400 | ||||||||
FaxNumber: | 4135855435 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2006 | ||||||||
LastUpdateDate: | 02/29/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN174272 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | RN174272 | MA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
ID | Type | State | Issuer | Description | 000000046870 | 01 | MA | BOSTON MEDICAL CENTER HEALTHNET PLAN | OTHER | 0342050 | 05 | MA |   | MEDICAID | 174272 | 01 | MA | CONNECTICARE OF MASS | OTHER | NP9939 | 01 | MA | BCBS OF MASS | OTHER |