Provider Demographics
NPI:1871605238
Name:BLANCHARD, CLARICE E (PA-C)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:E
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HUTCHINGS ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-2104
Mailing Address - Country:US
Mailing Address - Phone:515-462-2950
Mailing Address - Fax:515-462-4371
Practice Address - Street 1:300 W HUTCHINGS ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-2104
Practice Address - Country:US
Practice Address - Phone:515-462-2950
Practice Address - Fax:515-462-4371
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163410Medicaid
IA53959OtherBCBS
IAP01711Medicare UPIN
IA163410Medicaid