NPI 1386448728

Blaze Burkenstock, PA

Practitioner Medical Physician Assistant Mandeville, LA

Practice location

Address: 2040 N Causeway Blvd, Mandeville, LA 70471-3116
Phone: (985) 727-7676

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 346049 (LA)

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Registry record

NPI: 1386448728
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Apr 2025
Record last updated: 3 Apr 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.