1184681645 NPI number — MS. BEVERLY STARNER BLEDSOE RN

Table of content: MS. BEVERLY STARNER BLEDSOE RN (NPI 1184681645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184681645 NPI number — MS. BEVERLY STARNER BLEDSOE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEDSOE
Provider First Name:
BEVERLY
Provider Middle Name:
STARNER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184681645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1455
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGARLOAF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92386-1455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-247-4307
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10758 NAVAJO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92308-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-247-4307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0500X , with the licence number:  544328 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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