Provider Demographics
NPI:1053770404
Name:BLANCHARD, MITZI (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 E. 121ST ST. S.
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008
Mailing Address - Country:US
Mailing Address - Phone:918-403-7140
Mailing Address - Fax:
Practice Address - Street 1:7333 E. 121ST ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008
Practice Address - Country:US
Practice Address - Phone:918-403-7140
Practice Address - Fax:918-856-5392
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0072233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily