Provider Demographics
NPI:1487142600
Name:BLATTER, WANDA IRENE (APRN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:IRENE
Last Name:BLATTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MIAMI VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4783
Mailing Address - Country:US
Mailing Address - Phone:833-600-7873
Mailing Address - Fax:
Practice Address - Street 1:3313 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4023
Practice Address - Country:US
Practice Address - Phone:937-298-8084
Practice Address - Fax:937-298-0013
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily