| Doctor Name: | JENNIFER REBECCA BLASTOW |
| NPI Number: | 1023180569 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | CNP81266 |
| Business Practice Address: | 193 Main St Suite 1 Norway, ME - 042685645 |
| Business Phone Number: | 2077437721 |
| Business Fax Number: | 2077436306 |
| Mailing Address: | 301c Us Route 1, SCARBOROUGH |
| State: | ME |
| Postal Code: | 040749701 |
| Phone Number: | 2073968600 |
| Fax Number: | 2073968632 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 08/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CNP81266 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |