Provider Demographics
NPI:1548274467
Name:BLOUIN, JOANNE ELIZABETH (PAC)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:ELIZABETH
Last Name:BLOUIN
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:64 CONCORD STREET
Mailing Address - Street 2:STE C
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887
Mailing Address - Country:US
Mailing Address - Phone:978-988-9700
Mailing Address - Fax:978-988-9701
Practice Address - Street 1:64 CONCORD STREET
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887
Practice Address - Country:US
Practice Address - Phone:978-988-9700
Practice Address - Fax:978-988-9701
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA13363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13OtherLICENSE
043480187OtherTAX ID
MAMA0120395OtherCONTROL LIC
MAMA0120395OtherCONTROL LIC
MAAP1429Medicare ID - Type Unspecified