Provider Demographics
NPI:1700993201
Name:BLASENAK, ROBERTA F (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:F
Last Name:BLASENAK
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4559 WHETSTONE RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-8195
Mailing Address - Country:US
Mailing Address - Phone:865-774-6471
Mailing Address - Fax:
Practice Address - Street 1:801 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5018
Practice Address - Country:US
Practice Address - Phone:865-453-4434
Practice Address - Fax:865-428-3508
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4072466363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics