Provider Demographics
NPI:1164267241
Name:BLATTERT, RAQUEL FRANCES
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:FRANCES
Last Name:BLATTERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75700 ROMEO PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-2232
Mailing Address - Country:US
Mailing Address - Phone:586-530-9909
Mailing Address - Fax:
Practice Address - Street 1:55154 HANFORD CT
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3477
Practice Address - Country:US
Practice Address - Phone:586-530-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704373626163W00000X
MI4704373626NSA250GD363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse